Individual
EDWARD C CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11355 PEMBROOKE SQ, SUITE 107, WALDORF, MD 20603-4805
(301) 843-7711
(301) 932-9195
Mailing address
11355 PEMBROOKE SQ, SUITE 107, WALDORF, MD 20603-4805
(301) 843-7711
(301) 932-9195
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D0017492
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228502900
—
MD
Enumeration date
07/28/2005
Last updated
08/08/2016
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