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Individual

LAURENCE J CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8101 HINSON FARM RD, #119, ALEXANDRIA, VA 22306-3403
(703) 799-7300
(703) 799-8767
Mailing address
8101 HINSON FARM RD, #119, ALEXANDRIA, VA 22306-3403
(703) 799-7300
(703) 799-8767

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101030440
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
065941
ANTHEM HEALTHKEEPERS
VA
01
409113518
PALMETTO MEDICARE RAILROAD
DC
05
6086659
VA
Enumeration date
11/30/2005
Last updated
12/01/2009
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