Organization
WELLSBORO PEDIATRIC HEALTH CARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY A CLARK MD (OWNER)
(570) 724-7100
Entity
Organization
Contact information
Practice address
1B MAIN STREET, WELLSBORO, PA 16901-1601
(570) 724-7100
(570) 724-1501
Mailing address
1B MAIN STREET, WELLSBORO, PA 16901-1601
(570) 724-7100
(570) 724-1501
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD029130E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009089200001
—
PA
01
—
002502
FIRST PRIORITY
—
01
—
006529900
PERSONAL CHOICE
—
05
—
01032526
—
NY
01
—
050466997
BLUE SHIELD
NY
01
—
0606293
ACCESS CARE II
PA
01
—
070598
BLUE SHIELD
PA
01
—
13037
GHP
—
01
—
2603062
GHI
—
01
—
34219
UPMC
—
01
—
39D0980728
CLEA
PA
01
—
4623938
AETNA
—
01
—
794397
HEALTH CARE ADVANTAGE
—
01
—
CX28
HEALTH ASSURANCE
—
Enumeration date
12/13/2006
Last updated
10/24/2012
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