Provider Demographics
NPI:1396793949
Name:CLARK, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7529
Mailing Address - Country:US
Mailing Address - Phone:919-787-1374
Mailing Address - Fax:919-788-9007
Practice Address - Street 1:4600 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7529
Practice Address - Country:US
Practice Address - Phone:919-787-1374
Practice Address - Fax:919-788-9007
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-07-12
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Provider Licenses
StateLicense IDTaxonomies
VA35295207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1050087OtherUNITED HEALTHCARE
NC22601OtherBLUE CROSS
NC8922601Medicaid
NC040010474OtherRAILROAD MEDICARE
NCF24896Medicare UPIN
NC2169934Medicare ID - Type UnspecifiedMEDICARE