Clark, Vivian L

Clark, Vivian L is an individual health care provider with primary practice located at 1 Atwell Rd , Cooperstown NY 13326-1301. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Clark, Vivian L can be contacted via phone (607) 547-3909.

Contact Information

Primary practice address
1 Atwell Rd Cooperstown NY 13326-1301
Phone: (607) 547-3909
Fax: (607) 547-6325
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 233275 New York
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 233275 New York
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 233275 New York

Profile Details

NPI number 1427014737
LBN Legal business name Clark, Vivian L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Jul 8th, 2007 - about 19 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 1427014737 NPPES
New York MEDICAID 02588067

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