Provider Demographics
NPI:1659390029
Name:CLARK, LINDA G (MD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-348-4141
Mailing Address - Fax:740-348-7153
Practice Address - Street 1:1320 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:740-348-4141
Practice Address - Fax:740-348-7153
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD061063207P00000X
OH35-078519207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F88565Medicare UPIN
OHF88565Medicare UPIN
OHCL4231671Medicare PIN