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Individual
PETER CLARK
Active
Individual
PETER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
02894
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048350001
DMERC
NH
01
—
1207563Y0NH01
BLUE SHIELD NH
NH
01
—
30437
CIGNA
NH
01
—
702777
HARVARD PILGRIM
MA
01
—
803745
TUFTS
MA
Enumeration date
08/12/2005
Last updated
07/08/2007
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