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Individual

CHRISTOPHER TIMOTHY CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1924 ALCOA HWY, DEPARTMENT OF PATHOLOGY, KNOXVILLE, TN 37920-1511
(865) 305-8994
(865) 305-6866
Mailing address
20575 ERIE RD, ROCKY RIVER, OH 44116-1414
(216) 476-7108
(216) 476-7109

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
35.072415
OH
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
38281-020
WI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
44055
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000180176
OHIO OPERATING ENGINEERS
OH
05
1510737
TN
01
2042373
BCMH
OH
05
2042373
OH
01
340714618011
MEDICAL MUTUAL OF OHIO
OH
01
4203908
BCBS OF TN
TN
01
P00747161
RR MEDICARE PART B
TN
01
SY245065068
TRICARE
OH
Enumeration date
10/17/2006
Last updated
09/28/2010
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