Provider Demographics
NPI:1063672343
Name:CLARK, BARBARA ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:52 SHIRLEY ST
Mailing Address - City:GREEN HARBOR
Mailing Address - State:MA
Mailing Address - Zip Code:02041
Mailing Address - Country:US
Mailing Address - Phone:781-837-1357
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:SOUTH SHORE HOSPITAL
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-340-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical