Provider Demographics
NPI:1720249147
Name:CLARK, LINDA LEVITA (MD, MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEVITA
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:CLARK
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:237 RED HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4018
Mailing Address - Country:US
Mailing Address - Phone:585-720-9053
Mailing Address - Fax:585-227-9585
Practice Address - Street 1:301 EXCHANGE BLVD
Practice Address - Street 2:SUITE LL-1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2755
Practice Address - Country:US
Practice Address - Phone:585-227-0072
Practice Address - Fax:585-227-9585
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1943022083P0500X, 2083X0100X, 2083P0901X
NC2000010972083P0500X, 2083P0901X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY121959GJOtherPREFERRED CARE
NY194302OtherEXCELLUS ROCHESTER REGION
NY7413612OtherAETNA