Individual
MR. DYLAN ROSS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
1 BOSTON MEDICAL CENTER PLACE, BOSTON, MA 02118
(617) 638-6950
Mailing address
960 MASSACHUSETTS AVE, FLR 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2287470
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2287470
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110224269A
—
MA
05
—
3150309
—
NH
Enumeration date
01/06/2023
Last updated
04/02/2026
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