Provider Demographics
NPI:1568723575
Name:CLARK, RACHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
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 1:1316 W ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5220
Mailing Address - Country:US
Mailing Address - Phone:610-690-4490
Mailing Address - Fax:610-328-9391
Practice Address - Street 1:1316 W ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5220
Practice Address - Country:US
Practice Address - Phone:215-707-2400
Practice Address - Fax:215-707-4034
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD455148207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine