Individual
MICHAEL THOMAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, GROUND SILVERSTEIN, PHILADELPHIA, PA 19104-4206
(215) 662-6963
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP00179H
PA
Other
Enumeration date
09/13/2006
Last updated
05/09/2012
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