Provider Demographics
NPI:1467631408
Name:CLARK, HARRY WESTLEY (MD)
Entity Type:Individual
Prefix:
First Name:HARRY WESTLEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHOKE CHERRY ROAD
Mailing Address - Street 2:ROOM 5-1020
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20857-0001
Mailing Address - Country:US
Mailing Address - Phone:240-276-1660
Mailing Address - Fax:
Practice Address - Street 1:1 CHOKE CHERRY ROAD
Practice Address - Street 2:ROOM 5-1020
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20857-0001
Practice Address - Country:US
Practice Address - Phone:240-276-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA428232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry