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NPI Code Detail

MEDICARE: STEVEN D. CLARK RPA-C

MEDICARE: STEVEN D. CLARK RPA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant007751NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1007751OTHERNYLICENSE

General Provider Information

NPI Number : 1861498859
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN D. CLARK RPA-C
Provider Business Mailing Address
First Line : 14 MOUNTAIN LEDGE DRIVE
Second Line :
City : WILTON
State : NY
Zip : 12831-1858
Country : US
Telephone Number : 518-339-4839
Fax Number :
Provider Business Practice Location Address
First Line : 14 MOUNTAIN LEDGE DRIVE
Second Line :
City : WILTON
State : NY
Zip : 12831-1858
Country : US
Telephone Number : 518-339-4839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 02/25/2011

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Directions to “ STEVEN D. CLARK RPA-C” Practice Location

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