Provider Demographics
NPI:1710018775
Name:CLARK-BATTLE, PAULETTE LOUISE
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:LOUISE
Last Name:CLARK-BATTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 LIBERTY RD
Mailing Address - Street 2:APT.611
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5831
Mailing Address - Country:US
Mailing Address - Phone:443-200-2340
Mailing Address - Fax:443-200-2340
Practice Address - Street 1:6800 LIBERTY RD
Practice Address - Street 2:APT.611
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5831
Practice Address - Country:US
Practice Address - Phone:443-200-2340
Practice Address - Fax:443-200-2340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor