Individual
RYAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5501 OLD YORK RD, WILLLOWCREST BLDG., 4TH FLOOR, PHILADELPHIA, PA 19141-3018
(215) 456-1754
Mailing address
101 E OLNEY AVE, SUITE 400, PHILADELPHIA, PA 19120-2421
(215) 456-7000
(215) 254-2599
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA053613
PA
Other
Enumeration date
12/18/2008
Last updated
12/18/2008
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