Individual
DR. NATHAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 ELMWOOD AVE, BOX 604, ROCHESTER, NY 14642-0001
(585) 275-5982
(585) 756-0169
Mailing address
601 ELMWOOD AVE, BOX 604, ROCHESTER, NY 14642-0001
(585) 275-5982
(585) 756-0169
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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