Provider Demographics
NPI:1457495830
Name:CLARK, KUDIRATU ARANMOLATE (MD)
Entity Type:Individual
Prefix:DR
First Name:KUDIRATU
Middle Name:ARANMOLATE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUDIRATU
Other - Middle Name:ATINUKE
Other - Last Name:ARANMOLATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2730 UNIVERSITY BOULEVARD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1979
Mailing Address - Country:US
Mailing Address - Phone:301-942-8799
Mailing Address - Fax:301-933-8554
Practice Address - Street 1:2730 UNIVERSITY BOULEVARD
Practice Address - Street 2:SUITE 104
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1979
Practice Address - Country:US
Practice Address - Phone:301-942-8799
Practice Address - Fax:301-933-8554
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070652207L00000X
GA69565207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology