Clark, Michael Robert

Clark, Michael Robert is an individual health care provider with primary practice located at 3300 Gallows Rd , Falls Church VA 22042-3300. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Clark, Michael Robert can be contacted via phone (703) 776-4001.

Contact Information

Primary practice address
3300 Gallows Rd Falls Church VA 22042-3300
Phone: (703) 776-4001
Fax: (703) 776-7113
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X D35708 Maryland
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 0101263339 Virginia

Profile Details

NPI number 1124070024
LBN Legal business name Clark, Michael Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Oct 12th, 2020 - about 4 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 1124070024 NPPES
Maryland MEDICAID 417331700

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