Individual
KEVIN M CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
48 VIP WAY, FAIRMONT, WV 26554
(304) 366-6200
(304) 366-4927
Mailing address
200 RT 98 WEST, SUITE 107, NUTTER FORT, WV 26301
(304) 623-5711
(304) 624-0461
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
15547
WV
207R00000X
Internal Medicine Physician
15547
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722242
BCBS WV
WV
05
—
0041752000
—
WV
Enumeration date
08/08/2006
Last updated
08/15/2017
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