Provider Demographics
NPI:1528034147
Name:CLARK, SEAN (HS1)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:HS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOHEGAN AVE
Mailing Address - Street 2:USCG ACADEMY - MICHEL HALL
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-8100
Mailing Address - Country:US
Mailing Address - Phone:860-701-6904
Mailing Address - Fax:860-444-8413
Practice Address - Street 1:15 MOHEGAN AVE
Practice Address - Street 2:USCG ACADEMY - MICHEL HALL
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-8100
Practice Address - Country:US
Practice Address - Phone:860-701-6904
Practice Address - Fax:860-444-8413
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information