Clark, Carolyn A
Clark, Carolyn A is an individual health care provider with primary practice located at 43 Enterprise Dr , Bristol CT 06010-7457. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Clark, Carolyn A can be contacted via phone (860) 589-5230.Contact Information
Primary practice address
43 Enterprise Dr
Bristol CT 06010-7457
Phone: (860) 589-5230
Fax: (860) 589-5297
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036138 | Connecticut |
Profile Details
| NPI number | 1699757252 |
|---|---|
| LBN Legal business name | Clark, Carolyn A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 18th, 2005 |
| Last updated | Oct 8th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699757252 | NPPES |
| Connecticut | MEDICAID | 001361386 |
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