Clark, Edward C
Clark, Edward C is an sole proprietor health care provider with primary practice located at 11355 Pembrooke Sq Suite 107, Waldorf MD 20603-4805. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Clark, Edward C can be contacted via phone (301) 843-7711.Contact Information
Primary practice address
11355 Pembrooke Sq Suite 107
Waldorf MD 20603-4805
Phone: (301) 843-7711
Fax: (301) 932-9195
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | D0017492 | Maryland |
Profile Details
| NPI number | 1124028311 |
|---|---|
| LBN Legal business name | Clark, Edward C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Aug 8th, 2016 - about 8 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 | 1124028311 | NPPES |
| Maryland | MEDICAID | 228502900 |
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