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Organization

PREMIERE SPINE AND SPORTS MEDICINE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHRISTOPHER DAVID CLARK MD (OWNER/PHYSICIAN)
(252) 295-8685
Entity
Organization

Contact information

Practice address
13114 PENNSYLVANIA AVE, HAGERSTOWN, MD 21742-2741
(301) 800-7770
Mailing address
13114 PENNSYLVANIA AVE, HAGERSTOWN, MD 21742-3720
(301) 800-7770
(301) 800-7891

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
659938900
MD
Enumeration date
06/15/2017
Last updated
11/21/2024
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