Provider Demographics
NPI:1417602467
Name:DRS. MCCLOW, CLARK & BERK PA
Entity Type:Organization
Organization Name:DRS. MCCLOW, CLARK & BERK PA
Other - Org Name:MCB RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-388-6949
Mailing Address - Street 1:PO BOX 161180
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1180
Mailing Address - Country:US
Mailing Address - Phone:904-388-6949
Mailing Address - Fax:
Practice Address - Street 1:2300 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5571
Practice Address - Country:US
Practice Address - Phone:904-215-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty