Clark, Charles Edward

Clark, Charles Edward is an individual health care provider with primary practice located at 74 Munsill Ave Suite 100, Bristol VT 05443-1032. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Clark, Charles Edward can be contacted via phone (802) 453-5028.

Contact Information

Primary practice address
74 Munsill Ave Suite 100 Bristol VT 05443-1032
Phone: (802) 453-5028
Fax: (802) 453-6105
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0420006979 Vermont

Profile Details

NPI number 1609912427
LBN Legal business name Clark, Charles Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 29th, 2007
Last updated Sep 26th, 2013 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609912427 NPPES
Vermont MEDICAID VT5630

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