Clark, Marisol C

Clark, Marisol C is an individual health care provider with primary practice located at 1138 Lexington Rd Ste 290 , Georgetown KY 40324-9672. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Clark, Marisol C can be contacted via phone (502) 863-0721.

Contact Information

Primary practice address
1138 Lexington Rd Ste 290 Georgetown KY 40324-9672
Phone: (502) 863-0721
Fax: (502) 863-6104
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X 49101 Kentucky
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 49101 Kentucky

Profile Details

NPI number 1578613030
LBN Legal business name Clark, Marisol C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2007
Last updated Aug 17th, 2023 - about last year

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 1578613030 NPPES
Kentucky MEDICAID 7100443440

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