Active NPI
Carolyn E. Clark, M.D.
- Obstetrics & Gynecology Physician
- Huntington, WV
National Provider Identifier
1235274242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 13448
- Practice address
- 1124 19TH St
Huntington, WV 25701-3904 - Phone
- (304) 529-4117
- Fax
- (304) 529-4110
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 13448 | WV | Primary |
Addresses
Primary practice location
1124 19TH St
Huntington, WV 25701-3904
Mailing address
1124 19TH Street
Carolyn E. Clark, M.D., Inc.
Huntington, WV 25701-3904
Phone (304) 529-4117
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64695240 | Medicaid | KY | |
| 0094588000 | Medicaid | WV | |
| 0518961 | Medicaid | OH |
Other names 1
- Carolyn Lewis
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)
- Enrolled
- Credentials
- Doctor of Medicine
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Dr. Carolyn E. Clark
- Obstetrics & Gynecology Physician
- Huntington, WV
- NPI 1265567598
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1235274242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1124 19TH STREET",
"address_2": "CAROLYN E. CLARK, M.D., INC.",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257013904",
"telephone_number": "304-529-4117",
"fax_number": "304-529-4110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1124 19TH ST",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257013904",
"telephone_number": "304-529-4117",
"fax_number": "304-529-4110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CAROLYN",
"middle_name": "E.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "WV",
"license": "13448",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64695240",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0094588000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0518961",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CAROLYN",
"last_name": "LEWIS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Huntington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.