Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | MD059952L | PA |
Y | 207RH0002X | Hospice and Palliative Medicine | MD059952L | PA |
NPI | 1376507772 |
---|---|
Provider Name | Dr. Linda Clark |
First Address | Newtown Square, PA 19073-3622 |
Second Address | Newtown Square, PA 19073-3622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 12/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001664319 | (05) | PA |
01664319 | (05) | PA |
B72276 | (02) | PA |
P00798987 | RAILROAD MEDICARE (01) | PA |