Individual
CAROL A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1130 MEDICAL ARTS BLVD, SUITE 250, ANDERSON, IN 46011-3431
(765) 298-4282
(765) 298-4989
Mailing address
1130 MEDICAL ARTS BLVD, SUITE 250, ANDERSON, IN 46011-3431
(765) 298-4282
(765) 298-4989
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01030355A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000312561
ANTHEM
IN
05
—
200044780
—
IN
01
—
P00102150
RR MEDICARE
IN
Enumeration date
07/26/2006
Last updated
08/25/2011
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