Clark, Roger P.
Clark, Roger P. is an sole proprietor health care provider with primary practice located at 1153 Centre St Suite 4955, Boston MA 02130-3446. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Clark, Roger P. can be contacted via phone (617) 522-4943.Contact Information
Primary practice address
1153 Centre St Suite 4955
Boston MA 02130-3446
Phone: (617) 522-4943
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | 224283 | Massachusetts |
Profile Details
| NPI number | 1235181140 |
|---|---|
| LBN Legal business name | Clark, Roger P. |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 17th, 2006 |
| Last updated | Jun 18th, 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 | 1235181140 | NPPES |
| Massachusetts | Other | J42016 | BLUE CROSS/BLUE SHIELD OF MA |
| Massachusetts | MEDICAID | 2137437 | BLUE CROSS/BLUE SHIELD OF MA |
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