Donovan Deryl Clark, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

VA 0101057639 Issued in VA

Practice address

382 Taylor Dr
Danville, VA 24541

Phone

(434) 773-4240

Fax

(434) 773-4241

NPI assigned

Mar 24, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in VA

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Commonwealth of Virginia Department of Behavioral Health and Southern

  • Hospitalist Physician
  • Danville, VA
  • NPI 1386704898
  Medicare reassignment NPD
• Prince William County Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manassas, VA
  • NPI 1053402800
  Medicare reassignment NPD
• Prince William County

  • Ambulance
  • Prince William, VA
  • NPI 1235437385
  NPD

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1235199100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 TAYLOR DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24541",
            "telephone_number": "434-773-4240",
            "fax_number": "434-773-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 TAYLOR DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24541",
            "telephone_number": "434-773-4240",
            "fax_number": "434-773-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DONOVAN",
        "middle_name": "DERYL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "VA 0101057639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chosen Personal Care Services
• CHS Virginia Medical, PC
• Keyana Claiborne
• Mykala Denise Clardy
• Christy Marie Clark, AGACNP-BC
• Jada Nyiesha Clark
• Jessica Clark
• Kanchan Puri Clark, MD
• Nancy Coppic Clark, O.D.
• Tiffany Devon Clark

• Psychiatry Physician in Danville, VA
• Providers in Danville, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; 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.