Barry A Clark, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD029130E Issued in PA

Practice address

1B Main St
Wellsboro, PA 16901-1601

Phone

(570) 724-7100

Fax

(570) 724-1501

NPI assigned

Sep 22, 2006

Sex

Male

Sole proprietor

Yes

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.

• Wellsboro Pediatric Health Care Associates

  • Pediatrics Physician
  • Wellsboro, PA
  • NPI 1437210325

  Pediatrics

  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 28, 2012.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330387200000",
    "number": "1336249341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1B MAIN ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011601",
            "telephone_number": "570-724-7100",
            "fax_number": "570-724-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1B MAIN ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011601",
            "telephone_number": "570-724-7100",
            "fax_number": "570-724-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BARRY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2012-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD029130E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "0065299000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01032526",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "13037",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009089200001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPHC",
            "identifier": "304219",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4623938",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "002502",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2603062",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCESS CARE II",
            "identifier": "0606293",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLEA",
            "identifier": "39D0980728",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE ADVANTAGE",
            "identifier": "794397",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "CX28",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "070598",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Douglas Candelario, LPC
• Carleton Senior Care and Rehabilitation Center LLC
• Casey Loren Carpenter, PTA
• Amy Chalot
• William Douglas Chancellor, LCSW
• Mary Catherine Clark, MS, BSL, BSC, MT
• Ann J Cole, CRNP
• Concern Professional Services for Children, Youth, & Families
• Concern-Professional Services for Children, Youth & Families
• Concern-Professional Services for Children, Youth & Families

• All providers in Wellsboro, PA
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; 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.