Doctor Name: | CHAD MICHAEL CLARK |
NPI Number: | 1275517831 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 200400199 |
Business Practice Address: | 620 Summit Crossing Pl Ste 106 Gastonia, NC - 280542176 |
Business Phone Number: | 7048678021 |
Business Fax Number: | 7048644606 |
Mailing Address: | 620 Summit Crossing Pl, Ste 106 GASTONIA |
State: | NC |
Postal Code: | 280542176 |
Phone Number: | 7048678021 |
Fax Number: | 7048644606 |
NPI Enumeration Date: | 12/06/2005 |
NPI Last Update Date: | 08/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085B0100X |
License Number: | 200400199 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Body Imaging |
Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |