Individual
MR. MARK STEVEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1 VERNEY DRIVE, GREENFIELD, NH 03047
(603) 305-0628
Mailing address
38 CORTLAND DR, BEDFORD, NH 03110-4224
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0362
NH
363AM0700X
Medical Physician Assistant
Primary
0362
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30331005
—
NH
Enumeration date
12/21/2005
Last updated
03/18/2014
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