Individual
NISSE VIRGINIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-6850
Mailing address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
252130
MA
207VG0400X
Gynecology Physician
Primary
265956
MA
Other
Enumeration date
06/21/2012
Last updated
04/11/2018
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