Gavin Kestral Clark, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

D0106561 Issued in MD

Practice address

110 Irving St NW Ste Na1177
Washington, DC 20010-3017

Phone

(202) 373-9969

NPI assigned

Mar 14, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Georgetown University School of Medicine, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777075200000",
    "number": "1063160695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 IRVING ST NW STE NA1177",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200103017",
            "telephone_number": "202-373-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 IRVING ST NW STE NA1177",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200103017",
            "telephone_number": "202-373-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GAVIN",
        "middle_name": "KESTRAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-14",
        "last_updated": "2026-04-25",
        "certification_date": "2026-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "DC",
            "license": "MD60005590",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0106561",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101288809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebony Clark, LICSW
• Edward Clark
• Emma Clark
• Erika Edith Clark
• Erin A Clark
• Gloria Sharron Clark
• Gregory Odell Clark
• Hannah Jean Clark, MOT, OTR/L
• Heidi Clark, CPNP
• Herman Clark

• Emergency Medicine Physician in Washington, DC
• Providers in Washington, DC by specialty
• Emergency Medicine Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.