Individual
DR. GEORGE THOMAS CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3713 BENSON DRIVE, SUITE 201, CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA, RALEIGH, NC 27609-7372
(919) 235-3400
(919) 235-3401
Mailing address
3713 BENSON DRIVE, SUITE 201, RALEIGH, NC 27609-7372
(919) 235-3400
(919) 235-3401
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32073
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22713
BLUE CROSS/BLUE SHIELD
NC
01
—
3750391
UNITEDHEALTHCARE
NC
01
—
424855
AETNA
NC
01
—
803254
PARTNERS MEDICARE
NC
05
—
8922713
—
NC
01
—
C6338
MEDCOST
NC
01
—
P00016339
MEDICARE RAILROAD
NC
Enumeration date
06/08/2006
Last updated
02/01/2012
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