Individual
ANDREW RYAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5300 KIDSPEACE DR, OREFIELD, PA 18069-2044
(610) 799-8000
(610) 799-8801
Mailing address
5300 KIDSPEACE DR, OREFIELD, PA 18069-2044
(610) 799-8853
(610) 799-8001
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
MD439197
PA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD439197
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058450
LICENSE
GA
05
—
102671034-0001
—
PA
01
—
LL27954
LICENSE
SC
01
—
MD439197
LICENSE
PA
Enumeration date
09/27/2006
Last updated
07/21/2022
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