Individual
DR. CHARLES THOMAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
313 PARKS HALL, ATHENS, OH 45701
(740) 593-2444
(740) 593-0905
Mailing address
313 PARKS HALL, ATHENS, OH 45701
(740) 593-2444
(740) 593-0905
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34--003631
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0542158
—
OH
Enumeration date
02/06/2006
Last updated
05/31/2011
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