Individual
EDWARD JOSEPH CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1705 S. TARBORO ST, WILSON, NC 27893
(252) 399-8928
(252) 399-7313
Mailing address
PO BOX 12156, NEWPORT NEWS, VA 23612-2156
(757) 867-6101
(757) 867-6588
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
200101028
NC
2085R0204X
Vascular & Interventional Radiology Physician
200101028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1297G
BCBS
NC
05
—
891297G
—
NC
01
—
P00129619
RAILROAD MEDICARE
NC
Enumeration date
12/19/2006
Last updated
03/27/2024
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