Clark, Craig Charles

Clark, Craig Charles is an individual health care provider with primary practice located at 3650 Joseph Siewick Dr Suite 400, Fairfax VA 22033-1710. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Clark, Craig Charles can be contacted via phone (703) 391-2020.

Contact Information

Primary practice address
3650 Joseph Siewick Dr Suite 400 Fairfax VA 22033-1710
Phone: (703) 391-2020
Fax: (703) 391-1211
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101037862 Virginia

Profile Details

NPI number 1407840945
LBN Legal business name Clark, Craig Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2005
Last updated Nov 30th, 2007 - about 17 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 1407840945 NPPES
Virginia MEDICAID 05622514

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