Organization
PAUL R CLARK
Active
Other names
clark orthopedics co.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL R. CLARK (ORTHOTIST)
(617) 787-0504
Entity
Organization
Contact information
Practice address
1 BRAINTREE ST, ALLSTON, MA 02134-1602
(617) 787-0504
(781) 356-2074
Mailing address
P O BOX 850164, BRAINTREE, MA 02185
(617) 787-0504
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1537369
—
MA
01
—
375354
BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS
MA
01
—
670375
TUFT'S NAVIGATOR
MA
Enumeration date
01/10/2008
Last updated
10/29/2010
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