Provider Demographics
NPI:1598962847
Name:CLARK, STEPHEN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 SUTTER ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4003
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:917-591-6490
Practice Address - Street 1:162 E 78TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0406
Practice Address - Country:US
Practice Address - Phone:212-744-1100
Practice Address - Fax:877-732-3203
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2020-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL30146207R00000X
NY265229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine