Individual
ROGER P. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1153 CENTRE ST, SUITE 4955, BOSTON, MA 02130-3446
(617) 522-4943
Mailing address
1153 CENTRE ST, SUITE 4955, BOSTON, MA 02130-3446
(617) 522-4943
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
224283
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2137437
—
MA
01
—
J42016
BLUE CROSS/BLUE SHIELD OF MA
MA
Enumeration date
05/17/2006
Last updated
06/18/2008
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