Individual
THOMAS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4924 CAMPBELL BLVD, BALTIMORE, MD 21236-5908
(443) 442-2300
Mailing address
3100 WYMAN PARK DR, BALTIMORE, MD 21211-2803
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0000159
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970011935
RAILROAD MEDICARE
MD
Enumeration date
06/14/2006
Last updated
05/09/2013
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