Provider Demographics
NPI:1487688909
Name:CLOCK, MICHAEL P (RPA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CLOCK
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:800 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1019
Mailing Address - Country:US
Mailing Address - Phone:302-672-2319
Mailing Address - Fax:302-430-5448
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-347-5532
Practice Address - Fax:518-347-5409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-10-07
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Provider Licenses
StateLicense IDTaxonomies
NY003307-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53932Medicare UPIN