Individual
MR. ZACHARY ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(800) 346-7834
Mailing address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
03/29/2021
Last updated
07/08/2021
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