Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OT013929 | PA |
N | 111NI0900X | Internist | OT013929 | PA |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | OS019297 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | OS019297 | PA |
NPI | 1831484138 |
---|---|
Provider Name | Dr. John Michael Clark |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 26/06/2018 |