Individual
MICHAEL ROBERT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3300
(703) 776-4001
(703) 776-7113
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3300
(703) 776-4001
(703) 776-7113
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101263339
VA
2084P0800X
Psychiatry Physician
D35708
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417331700
—
MD
Enumeration date
05/17/2006
Last updated
10/12/2020
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