Individual
CAROLYN A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
43 ENTERPRISE DR, BRISTOL, CT 06010-7457
(860) 589-5230
(860) 589-5297
Mailing address
43 ENTERPRISE DR, BRISTOL, CT 06010-7457
(860) 589-5230
(860) 589-5297
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036138
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001361386
—
CT
Enumeration date
11/18/2005
Last updated
10/08/2015
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