Clark, Jay Bradford
Clark, Jay Bradford is an sole proprietor health care provider with primary practice located at 4807 Benson Ave. , Baltimore MD 21227-1530. He recently has 4 registered licenses in different health care specialties including Other Service Providers / Specialist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Geriatrics, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic is his primary health care specialty. Clark, Jay Bradford can be contacted via phone (410) 242-8963.Contact Information
Primary practice address
4807 Benson Ave.
Baltimore MD 21227-1530
Phone: (410) 242-8963
Fax: (410) 242-8965
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 18491 | Maryland |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | 18491 | Maryland |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Geriatrics | 2251G0304X | 18491 | Maryland |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics | 2251P0200X | 18491 | Maryland |
Profile Details
| NPI number | 1235255837 |
|---|---|
| LBN Legal business name | Clark, Jay Bradford |
| Credentials | DSCPT, MPT |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 22nd, 2007 |
| Last updated | Jul 17th, 2009 - about 16 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 | 1235255837 | NPPES |
| Maryland | MEDICAID | 020880900 |
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