Individual
TIMOTHY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 W ARLINGTON BLVD STE 210, GREENVILLE, NC 27834-5758
(252) 752-5000
(252) 931-7694
Mailing address
PO BOX 30750, GREENVILLE, NC 27833-0750
(252) 752-5000
(252) 931-7694
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0028742
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22739
BLUE CROSS BLUE SHIELD NORTH CAROLING
NC
05
—
8922739
—
NC
Enumeration date
11/10/2005
Last updated
09/01/2016
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