Charles Malcolm Clark Jr., MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

01020086A Issued in IN

Practice address

2802 Lafayette Road Suite 13
Eagledale Health Center
Indianapolis, IN 46222-2112

Phone

(317) 923-7510

Fax

(317) 923-7518

NPI assigned

Sep 26, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1124301106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 LAFAYETTE ROAD SUITE 13",
            "address_2": "EAGLEDALE HEALTH CENTER",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462222112",
            "telephone_number": "317-923-7510",
            "fax_number": "317-923-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 LAFAYETTE ROAD SUITE 13",
            "address_2": "EAGLEDALE HEALTH CENTER",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462222112",
            "telephone_number": "317-923-7510",
            "fax_number": "317-923-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "MALCOLM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01020086A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Belden Clark, PHARMD
• Brendon Matthew Clark
• Brittney Le'Shai Clark
• Cameron Clark, RBT
• Carol Clark, CNP
• Cherie Clark, M.A.
• Cordell L Clark
• David Clark
• David Glenn Clark, MD
• Eleanor Ann Clark, LMHC-A

• Endocrinology, Diabetes & Metabolism Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Endocrinology, Diabetes & Metabolism Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.