Provider Demographics
NPI:1881654572
Name:CLARK, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
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 1:2209 S STERLING ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4092
Mailing Address - Country:US
Mailing Address - Phone:828-580-4577
Mailing Address - Fax:828-580-4599
Practice Address - Street 1:2209 S STERLING ST STE 600
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4092
Practice Address - Country:US
Practice Address - Phone:828-580-4577
Practice Address - Fax:828-580-4599
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401186207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138MWMedicaid
NC1881654572Medicaid
NC1881654572Medicaid
NC2036018Medicare ID - Type Unspecified