Provider Demographics
NPI:1497053557
Name:CENTER FOR WEIGHT LOSS SUCCESS, P.C.
Entity Type:Organization
Organization Name:CENTER FOR WEIGHT LOSS SUCCESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MD, FACS
Authorized Official - Phone:757-873-1880
Mailing Address - Street 1:645 J CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1819
Mailing Address - Country:US
Mailing Address - Phone:757-873-1880
Mailing Address - Fax:757-873-1990
Practice Address - Street 1:645 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1819
Practice Address - Country:US
Practice Address - Phone:757-873-1880
Practice Address - Fax:757-873-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050712208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty