Clark, Thomas W

Clark, Thomas W is an individual health care provider with primary practice located at 645 J Clyde Morris Blvd , Newport News VA 23601-1819. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Clark, Thomas W can be contacted via phone (757) 591-9572.

Contact Information

Primary practice address
645 J Clyde Morris Blvd Newport News VA 23601-1819
Phone: (757) 591-9572
Fax: (757) 591-9606
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0101050712 Virginia

Profile Details

NPI number 1255494183
LBN Legal business name Clark, Thomas W
Credentials M.S., M.D., F.A.C.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2006
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 1255494183 NPPES
Virginia Other 453810 ANTHEM
Virginia MEDICAID 7312059 ANTHEM

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