Provider Demographics
NPI:1134480668
Name:CLARK, CHRISTOPHER JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JEROME
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2704 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3633
Mailing Address - Country:US
Mailing Address - Phone:336-663-5700
Mailing Address - Fax:336-663-5734
Practice Address - Street 1:2704 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-663-5700
Practice Address - Fax:336-663-5734
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-020912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery