Provider Demographics
NPI:1225005564
Name:CLARK, NEIL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ROSS
Last Name:CLARK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:217 HARRISBURG AVE
Mailing Address - Street 2:THE HEART GROUP OF LGHEALTH
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2964
Mailing Address - Country:US
Mailing Address - Phone:717-544-8300
Mailing Address - Fax:717-544-8265
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:THE HEART GROUP OF LGHEALTH
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:717-544-8300
Practice Address - Fax:717-544-8265
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-05-22
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Provider Licenses
StateLicense IDTaxonomies
PAMD036920207UN0901X
PAMD036920E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010946100008Medicaid
PA0010946100008Medicaid
PA0010946100008Medicaid