Individual
DR. KIMBALL G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, 3RD FLOOR RADIOLOGY, SYRACUSE, NY 13210-2306
(315) 464-6672
Mailing address
224 HARRISON ST, SUITE 601, SYRACUSE, NY 13202-3056
(315) 464-5660
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
1547881
NY
2085R0202X
Diagnostic Radiology Physician
Primary
1547881
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01013661
—
NY
Enumeration date
06/10/2006
Last updated
03/18/2008
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