Provider Demographics
NPI:1528288339
Name:CLARK, PATRICIA ELLEN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELLEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 LAMONT NORWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7002
Mailing Address - Country:US
Mailing Address - Phone:919-967-5766
Mailing Address - Fax:919-929-3722
Practice Address - Street 1:307 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2119
Practice Address - Country:US
Practice Address - Phone:919-542-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC303132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910964Medicaid
NC22550OtherBCBS
NC22550OtherBCBS
NC8910964Medicaid