Provider Demographics
NPI:1225356355
Name:CLARK, WESLEY HURST (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:HURST
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:457 STATE ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1864
Mailing Address - Country:US
Mailing Address - Phone:718-986-8391
Mailing Address - Fax:
Practice Address - Street 1:457 STATE ST APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1864
Practice Address - Country:US
Practice Address - Phone:718-986-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0012930207L00000X
NY272912207L00000X
NJ25MA09563000207L00000X
NH17811207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology