Clark, Kimball G

Clark, Kimball G is an individual health care provider with primary practice located at 750 E Adams St 3Rd Floor Radiology, Syracuse NY 13210-2306. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuroradiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Clark, Kimball G can be contacted via phone (315) 464-6672.

Contact Information

Primary practice address
750 E Adams St 3Rd Floor Radiology Syracuse NY 13210-2306
Phone: (315) 464-6672
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuroradiology 2085N0700X 1547881 New York
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 1547881 New York

Profile Details

NPI number 1689615502
LBN Legal business name Clark, Kimball G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2006
Last updated Mar 18th, 2008 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689615502 NPPES
New York MEDICAID 01013661

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