Provider Demographics
NPI:1427022029
Name:CLARK, BETH A (DO)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 56
Mailing Address - Street 2:
Mailing Address - City:FISHERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15539
Mailing Address - Country:US
Mailing Address - Phone:814-839-4152
Mailing Address - Fax:
Practice Address - Street 1:2040 QUAKER VALLEY RD
Practice Address - Street 2:
Practice Address - City:FISHERTOWN
Practice Address - State:PA
Practice Address - Zip Code:15539-9723
Practice Address - Country:US
Practice Address - Phone:814-839-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAH59934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057555PEEMedicare ID - Type Unspecified
PAH59934Medicare UPIN