Individual
DR. CAROLYN CLARK
Active
Individual
DR. CAROLYN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101057337
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033156617
—
VA
01
—
110165956
RAILROAD MEDICARE
VA
01
—
294398
SOUTHERN HEALTH
VA
01
—
393746
ANTHEM
VA
01
—
5427630
AETNA
VA
01
—
7236246
CIGNA
VA
Enumeration date
06/01/2006
Last updated
04/05/2011
Update your record
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