Individual
DR. NATHAN CLARK
Active
Individual
DR. NATHAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
228078
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00372225
—
NY
05
—
02410286
—
NY
01
—
2222
BLUE SHIELD GROUP#
NY
01
—
5397952
GHI PROVIDER#
NY
01
—
7829472
AETNA PROVIDER#
NY
01
—
CC0135
RAILROAD MEDICARE GROUP#
NY
01
—
G0189393590
BLUE CHOICE GROUP#
NY
01
—
MDH505
PREFERRED CARE#
NY
01
—
P00013266
RAILROAD MEDICARE PROVIDE
NY
01
—
P010228078
BLUE CHOICE PROVIDER#
NY
Enumeration date
07/17/2006
Last updated
07/05/2023
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