Individual
DR. DAVID CHARLES CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1331 NORTH ELM STREET, SUITE 200, GREENSBORO, NC 27401-6304
(336) 274-9614
(336) 482-2177
Mailing address
PO BOX 63112, CHARLOTTE, NC 28263-3112
(336) 274-9617
(336) 482-2177
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
39405
NC
2085R0202X
Diagnostic Radiology Physician
39405
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600796
UNITED HEALTHCARE
NC
01
—
1720079767
VIRGINIA MEDICAID
VA
01
—
18290
PARTNERS
NC
01
—
22555
BLUE CROSS BLUE SHIELD
NC
01
—
300050409
RAILROAD MEDICARE
NC
01
—
70507
MEDCOST
NC
05
—
8922555
—
NC
Enumeration date
10/31/2005
Last updated
03/10/2023
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