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1982600789

NPI Code Detail

MEDICARE: DR. ROBERT EARL CLARK M.D., PHD

MEDICARE: DR. ROBERT EARL CLARK M.D., PHD

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
1	207N00000X	Dermatology Physician	31121	NC
2	207ND0101X	MOHS-Micrographic Surgery Physician	31121	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	070012681	OTHER	NC	RETIRED RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	562070218C	OTHER	NC	CIGNA
3	9715177001	OTHER	NC	CIGNA HEALTHCARE
4	0354066	OTHER	NC	UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	81690	OTHER	NC	MEDCOST
7	11591	OTHER	NC	BCBS
8	13334	OTHER	NC	DOCTOR'S HEALTH PLAN
9	2046860	OTHER	NC	AETNA HMO
10	259852	OTHER	NC	MAMSI
11	13123	OTHER	NC	PARTNERS
12	4347967	OTHER	NC	AETNA PPO

General Provider Information

NPI Number	:	1982600789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EARL CLARK M.D., PHD

Provider Business Mailing Address
First Line	:	200 WELLESLEY TRADE LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-5576
Country	:	US
Telephone Number	:	919-363-7546
Fax Number	:	919-363-3616

Provider Business Practice Location Address
First Line	:	200 WELLESLEY TRADE LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-5576
Country	:	US
Telephone Number	:	919-363-7546
Fax Number	:	919-363-3616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/29/2020

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Directions to “ DR. ROBERT EARL CLARK M.D., PHD” Practice Location

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