Clark, David Glenn

Clark, David Glenn is an individual health care provider with primary practice located at 171 Ashley Ave , Charleston SC 29425-8908. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Clark, David Glenn can be contacted via phone (843) 792-1414.

Contact Information

Primary practice address
171 Ashley Ave Charleston SC 29425-8908
Phone: (843) 792-1414
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 21639 Alabama
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 37037 South Carolina

Profile Details

NPI number 1790728459
LBN Legal business name Clark, David Glenn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jun 27th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790728459 NPPES
Alabama Other 051529988 BLUE CROSS
Alabama Other 051529987 BLUE CROSS
Alabama MEDICAID 009932389 BLUE CROSS
Alabama MEDICAID 009932394 BLUE CROSS
Alabama Other G82404 BLUE CROSS
Alabama Other P00313093 BLUE CROSS

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