Clark, John L
Clark, John L is an individual health care provider with primary practice located at 5 Perryridge Rd , Greenwich CT 06830-4608. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Clark, John L can be contacted via phone (203) 661-5330.Contact Information
Primary practice address
5 Perryridge Rd
Greenwich CT 06830-4608
Phone: (203) 661-5330
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 018090 | Connecticut |
Profile Details
| NPI number | 1366471005 |
|---|---|
| LBN Legal business name | Clark, John L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 3rd, 2006 |
| Last updated | Mar 31st, 2008 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366471005 | NPPES |
| Connecticut | MEDICAID | 001180900 |
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