Individual
CRAIG CHARLES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3650 JOSEPH SIEWICK DR, SUITE 400, FAIRFAX, VA 22033-1710
(703) 391-2020
(703) 391-1211
Mailing address
3650 JOSEPH SIEWICK DR, SUITE 400, FAIRFAX, VA 22033-1710
(703) 391-2020
(703) 391-1211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101037862
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05622514
—
VA
Enumeration date
09/09/2005
Last updated
11/30/2007
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