Individual
DR. THOMAS W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., M.D., F.A.C.S.
Contact information
Practice address
645 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1819
(757) 591-9572
(757) 591-9606
Mailing address
645 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1819
(757) 591-9572
(757) 591-9606
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101050712
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
453810
ANTHEM
VA
05
—
7312059
—
VA
Enumeration date
12/19/2006
Last updated
07/08/2007
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