Individual
DR. JUSTIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
99 CAMPUS AVE, SUITE 303, LEWISTON, ME 04240-6045
(207) 782-5424
(207) 782-1136
Mailing address
PO BOX 1638, ALBANY, NY 12201-1638
(207) 777-4111
(207) 783-6660
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
215216
MA
Other
Enumeration date
01/04/2006
Last updated
02/15/2012
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