Provider Demographics
NPI:1376549022
Name:SCHUH-CLARK, MARY THERESA (DPM)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:SCHUH-CLARK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:SCHUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:795 E 2ND ST STE 7
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3877
Mailing Address - Fax:
Practice Address - Street 1:795 E 2ND ST STE 7
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3877
Practice Address - Fax:909-706-3942
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5996213EP1101X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023310Medicaid
VT1023310Medicaid
NJV02572Medicare UPIN
CAV02572Medicare UPIN
NJ0054585Medicaid
VT1023310Medicaid
CAFE346ZMedicare PIN
CAFE346YMedicare PIN