1356409676 NPI number — LINDA L. CLARK, M.D., M.S., P.C.

Table of content: (NPI 1356409676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356409676 NPI number — LINDA L. CLARK, M.D., M.S., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA L. CLARK, M.D., M.S., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356409676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 EXCHANGE BLVD
Provider Second Line Business Mailing Address:
SUITE LL-1
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14608-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-227-0072
Provider Business Mailing Address Fax Number:
585-227-9585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 EXCHANGE BLVD
Provider Second Line Business Practice Location Address:
SUITE LL-1
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14608-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-227-0072
Provider Business Practice Location Address Fax Number:
585-227-9585
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
LEVITA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-227-0072

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  194302 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: 200001097 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: 194302 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083X0100X , with the licence number: 200001097 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121959GJ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010194302 . This is a "EXCELLUS ROCHESTER REGION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7413612 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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