Provider Demographics
NPI:1013029651
Name:RISK, CLIFFORD GEORGE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:GEORGE
Last Name:RISK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:320 BOLTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3980
Mailing Address - Country:US
Mailing Address - Phone:508-481-4288
Mailing Address - Fax:508-624-7228
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3980
Practice Address - Country:US
Practice Address - Phone:508-481-4288
Practice Address - Fax:508-624-7228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA47576173000000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6166164Medicaid
MA6166164Medicaid
MAA66274Medicare UPIN