Individual
HEATHER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9815 MAIN ST STE 208, DAMASCUS, MD 20872
(301) 253-4004
(301) 253-3391
Mailing address
9815 MAIN ST STE 208, DAMASCUS, MD 20872-2099
(301) 253-4004
(301) 253-3391
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C0005635
MD
363A00000X
Physician Assistant
Primary
C0005635
MD
Other
Enumeration date
11/25/2014
Last updated
07/11/2019
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