Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 132735 | NY |
N | 2080N0001X | Neonatal-Perinatal Doctor | 132735 | NY |
NPI | 1114929650 |
---|---|
Provider Name | Dr. David Albert Clark |
First Address | Albany, NY 12208-3412 |
Second Address | Albany, NY 12208-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00547080 | (05) | NY |
A60635 | (02) | NY |