Clark, Max A

Clark, Max A is an individual health care provider with primary practice located at 1975 Miamisburg Centerville Rd Suite A, Centerville OH 45459-3811. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gynecology, Allopathic & Osteopathic Physicians / Gynecologic Oncology. Allopathic & Osteopathic Physicians / Gynecology is his primary health care specialty. Clark, Max A can be contacted via phone (937) 438-1340.

Contact Information

Primary practice address
1975 Miamisburg Centerville Rd Suite A Centerville OH 45459-3811
Phone: (937) 438-1340
Fax: (937) 438-4802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 34003865 Ohio
Allopathic & Osteopathic Physicians / Gynecologic Oncology 207VX0201X 34003865 Ohio

Profile Details

NPI number 1538152749
LBN Legal business name Clark, Max A
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Jul 8th, 2007 - about 18 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 1538152749 NPPES
Ohio MEDICAID 0803367

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