Individual
DR. MICHAEL B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2002 MEDICAL PKWY, STE 235, ANNAPOLIS, MD 21401-3046
(410) 266-2770
(410) 841-6251
Mailing address
2002 MEDICAL PKWY, STE 235, ANNAPOLIS, MD 21401-3046
(410) 266-2770
(410) 841-6251
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
D0056183
MD
2085R0202X
Diagnostic Radiology Physician
200000198
NC
2085R0202X
Diagnostic Radiology Physician
28302
SC
2085R0202X
Diagnostic Radiology Physician
35.080358
OH
2085R0202X
Diagnostic Radiology Physician
MD416976
PA
2085R0202X
Diagnostic Radiology Physician
ME94700
FL
2085R0204X
Vascular & Interventional Radiology Physician
D0056183
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017000300
—
MD
01
—
019419A80
AAD PG COUNTY
MD
01
—
10690029
BCBS
MD
01
—
2622593
AETNA HMO/POS
MD
01
—
8317071
AETNA PPO
MD
01
—
N899
AAD AA COUNTY
MD
Enumeration date
05/25/2006
Last updated
02/27/2009
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