Individual
DR. JAMES ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 WINDING RIVER LN STE 102, CHARLOTTESVILLE, VA 22911-3589
(434) 817-2442
Mailing address
325 WINDING RIVER LN STE 102, CHARLOTTESVILLE, VA 22911-3589
(434) 817-2442
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101050599
VA
207R00000X
Internal Medicine Physician
155019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
271538
BLUE CROSS BLUE SHIELD
VA
01
—
49D0940134
CLIA NUMBER
VA
01
—
541857642
TRICARE PROVIDER NUMBER
VA
Enumeration date
01/23/2007
Last updated
04/29/2022
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