Individual
ANN MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-5722
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4612
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110192A
—
MA
Enumeration date
02/04/2013
Last updated
01/27/2025
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