Individual
PETER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
785 CENTRAL RD, RYE BEACH, NH 03871-9005
(603) 964-7740
(603) 964-7783
Mailing address
325 MAIN ST, PO BOX 882, PLAISTOW, NH 03865-3033
(603) 382-5400
(603) 382-4283
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
02894
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048350001
DMERC
NH
01
—
1207563Y0NH01
BLUE SHIELD NH
NH
01
—
30437
CIGNA
NH
01
—
702777
HARVARD PILGRIM
MA
01
—
803745
TUFTS
MA
Enumeration date
08/12/2005
Last updated
07/08/2007
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