Individual
MRS. MARY HOLLAND HOBACK CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
BARRON DR, INSTITUTE, WV 25112-1004
(304) 766-4855
(304) 766-4954
Mailing address
PO BOX 1004, BARRON DR, INSTITUTE, WV 25112-1004
(304) 766-4855
(304) 766-4954
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10892
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116792000
—
WV
01
—
10892
WV BD OF MEDECINE
WV
Enumeration date
01/09/2006
Last updated
07/09/2007
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