Provider Demographics
NPI:1073969267
Name:LORNA J. CLARK MD PLLC
Entity Type:Organization
Organization Name:LORNA J. CLARK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-561-0063
Mailing Address - Street 1:11 HAMMOND LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2003
Mailing Address - Country:US
Mailing Address - Phone:518-561-0063
Mailing Address - Fax:518-561-0947
Practice Address - Street 1:11 HAMMOND LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2003
Practice Address - Country:US
Practice Address - Phone:518-561-0063
Practice Address - Fax:518-561-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty