# CAROLYN E CLARK MD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DR. CAROLYN E. CLARK
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265567598
- **Authorized official:** CAROLYN E CLARK M.D. (PRESIDENT)
- **Authorized official phone:** (304) 529-4117

## Contact information

- **Practice address:** 1124 19TH ST, HUNTINGTON, WV 25701-3904
- **Practice address phone:** (304) 529-4117
- **Practice address fax:** (304) 529-4117
- **Mailing address:** 1124 19TH ST, HUNTINGTON, WV 25701-3904
- **Mailing address phone:** (304) 529-4117
- **Mailing address fax:** (304) 529-4117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 07/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0965817 | — | OH |
| 05 | — | 3810005901 | — | WV |