Mary E Clark, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

282335 Issued in MA

Practice address

163 Veterans Drive
White River Junction, VT 05009-4728

Phone

(508) 776-8014

NPI assigned

Aug 28, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mary E Hunnewell Former name

Medicare fee-for-service enrollment

Enrolled in NV

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

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": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1104174846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N MAIN ST",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050090001",
            "telephone_number": "508-776-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 VETERANS DRIVE",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050094728",
            "telephone_number": "508-776-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-28",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NE",
            "license": "27610",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "RI",
            "license": "LP05113",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "282335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HUNNEWELL",
            "middle_name": "E",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aleksey Chernov, PHARMD
• Josephine Choi, OD
• Rebecca Chollet, N.D.
• Lynne Casey Chow, MSN FNP
• Cort Christoffers, RRT
• Robin Clavelle, RD
• Kristen D Coats, NON-CLINICAL THERAP
• Nancy Cochran, MD
• Brady H Cole, MA
• Justin Michael Cole, O.D.

• Anatomic Pathology & Clinical Pathology Physician in White River Junction, VT
• Providers in White River Junction, VT by specialty
• Anatomic Pathology & Clinical Pathology Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.