Active NPI
Gregg P Clark
- Home Modifications Contractor
- Wilmington, DE
National Provider Identifier
1053852608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 1990063352
- Practice address
- 113 Smyrna Ave
Wilmington, DE 19809-1234 - Phone
- (302) 218-1137
- NPI assigned
- Mar 15, 2017
- Last updated
- Mar 15, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 1990063352 | DE | Primary |
Addresses
Primary practice location
113 Smyrna Ave
Wilmington, DE 19809-1234
Mailing address
113 Smyrna Ave
Wilmington, DE 19809-1234
Phone (302) 218-1137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1990063352 | DE | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1053852608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 SMYRNA AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198091234",
"telephone_number": "302-218-1137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 SMYRNA AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198091234",
"telephone_number": "302-218-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GREGG",
"middle_name": "P",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-15",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "DE",
"license": "1990063352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.