# M JUSTINE CLARK, DO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700953007
- **Authorized official:** DR. M JUSTINE CLARK DO (OWNER)
- **Authorized official phone:** (410) 573-2292

## Contact information

- **Practice address:** 600 RIDGELY AVE, SUITE 214, ANNAPOLIS, MD 21401
- **Practice address phone:** (410) 573-2292
- **Mailing address:** 600 RIDGELY AVE, SUITE 214, ANNAPOLIS, MD 21401
- **Mailing address phone:** (410) 573-2292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | H41992 | MD | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 08/22/2020