Provider Demographics
NPI:1477176303
Name:STALLINGS, CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:
Last Name:STALLINGS
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 1:4924 CAMPBELL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5914
Mailing Address - Country:US
Mailing Address - Phone:443-442-2300
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5914
Practice Address - Country:US
Practice Address - Phone:443-442-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD96610207R00000X
PAMT220667390200000X
MDD0096610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program