Individual
TIMOTHY WILLIAM INGRAHAM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 N. 39TH STREET, PHILADELPHIA, PA 19104
(215) 662-3005
Mailing address
51 N. 39TH STREET, PHILADELPHIA, PA 19104
(215) 662-3005
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD065636L
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD065636L
PA
Other
Enumeration date
04/19/2006
Last updated
04/18/2018
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