Provider Demographics
NPI:1164677415
Name:CLARK, KAREN HARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:HARRELL
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ENVIRON WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-4426
Mailing Address - Country:US
Mailing Address - Phone:919-240-7269
Mailing Address - Fax:
Practice Address - Street 1:1240 ENVIRON WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4426
Practice Address - Country:US
Practice Address - Phone:919-240-7269
Practice Address - Fax:919-240-7816
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30300207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82998Medicare UPIN
NC205068FMedicare PIN