Individual
JEANNE M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-9434
Mailing address
PO BOX 64264, BALTIMORE, MD 21264-4264
(410) 614-1135
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D52126
MD
2085R0202X
Diagnostic Radiology Physician
Primary
25MA08297800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
773500600
—
MD
Enumeration date
05/17/2006
Last updated
05/14/2025
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