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Individual

DR. RICHARD CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
181 N BELLE MEAD RD, EAST SETAUKET, NY 11733-3495
(631) 444-4200
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-4200

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
181488
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01175460
NY
Enumeration date
06/06/2006
Last updated
12/06/2013
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