Provider Demographics
NPI:1508841487
Name:CLARK, ERIKA H (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:H
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1451 HARRODSBURG RD
Mailing Address - Street 2:SUITE D-502
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3758
Mailing Address - Country:US
Mailing Address - Phone:859-277-8560
Mailing Address - Fax:859-277-8866
Practice Address - Street 1:1451 HARRODSBURG RD
Practice Address - Street 2:SUITE D-502
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3758
Practice Address - Country:US
Practice Address - Phone:859-277-8560
Practice Address - Fax:859-277-8866
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041817OtherANTHEM
KYH65571Medicare UPIN
KY000000041817OtherANTHEM