Provider Demographics
NPI:1508886987
Name:CLARKSON, MARK A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HEALTH CENTER DRIVE
Mailing Address - Street 2:PO BOX 590
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983
Mailing Address - Country:US
Mailing Address - Phone:304-772-3064
Mailing Address - Fax:304-772-3296
Practice Address - Street 1:2869 SENECA TRIAL
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963
Practice Address - Country:US
Practice Address - Phone:304-753-4336
Practice Address - Fax:304-753-4097
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2175207Q00000X
VA0102203610208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA237710OtherBCBS
WVCL2027561Medicare PIN
WVCD7656OtherRR MC
WV001706661OtherBCBS
WVP00331834OtherRR MC
WVI56403Medicare UPIN
WV511856Medicare Oscar/Certification
WV5118561Medicare Oscar/Certification
WV001898577OtherBCBS
WV0035334000Medicaid
WV511860Medicare Oscar/Certification
WV5118601Medicare Oscar/Certification
WV3810005814Medicaid
WVPO0331834OtherRR MC