Provider Demographics
NPI:1821251943
Name:CLARK, VICTOR PIERRE (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:PIERRE
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2018-00776208M00000X
IN01083360207R00000X
VA0101247340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10121062OtherOPTIMA HEALTH
VAPAROtherCORVEL
VA1821251943OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VA1821251943Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VAP01080343Medicare PIN
VA10121062OtherOPTIMA HEALTH
VAPAROtherMULTIPLAN
VAVV6113AMedicare PIN