Organization
EDWARD C. CLARK,M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD C CLARK M.D. (OWNER)
(301) 843-7711
Entity
Organization
Contact information
Practice address
11355 PEMBROOKE SQ, SUITE 107, WALDORF, MD 20603-4805
(301) 843-7711
(301) 932-9195
Mailing address
11355 PEMBROOKE SQ, SUITE 107, WALDORF, MD 20603-4805
(301) 843-7711
(301) 932-9195
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D0017492
MD
Other
Enumeration date
07/29/2005
Last updated
08/22/2020
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