# DR. MICHAEL B CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538115423
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085N0700X | Neuroradiology Physician | D0056183 | MD | Yes |
| 2085R0202X | Diagnostic Radiology Physician | 200000198 | NC | — |
| 2085R0202X | Diagnostic Radiology Physician | 28302 | SC | — |
| 2085R0202X | Diagnostic Radiology Physician | 35.080358 | OH | — |
| 2085R0202X | Diagnostic Radiology Physician | MD416976 | PA | — |
| 2085R0202X | Diagnostic Radiology Physician | ME94700 | FL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | D0056183 | MD | — |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 02/27/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 017000300 | — | MD |
| 01 | — | 019419A80 | AAD PG COUNTY | MD |
| 01 | — | 10690029 | BCBS | MD |
| 01 | — | 2622593 | AETNA HMO/POS | MD |
| 01 | — | 8317071 | AETNA PPO | MD |
| 01 | — | N899 | AAD AA COUNTY | MD |