Provider Demographics
NPI:1487690244
Name:CLARK, CYNTHIA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNNE
Other - Last Name:CLARK-SEGELKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:154-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:468 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1928
Practice Address - Country:US
Practice Address - Phone:650-227-1150
Practice Address - Fax:650-227-1107
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine