Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 226853 | MA |
NPI | 1437159795 |
---|---|
Provider Name | Dr. Brian M Clark |
First Address | Millbury, MA 01527-2677 |
Second Address | Millbury, MA 01527-2677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2112191 | (05) | MA |
G73253 | (02) | MA |