Individual
MR. DEREK ANTHONY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 SPRING GARDEN ST, PHILADELPHIA, PA 19123-3206
(215) 769-3561
Mailing address
1235 SPRING GARDEN ST, PHILADELPHIA, PA 19123-3206
(215) 769-3561
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024869940002
—
PA
Enumeration date
01/13/2023
Last updated
01/13/2023
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