Active NPI
Chester Irvin Clark II, M.D.
- Family Medicine Physician
- Horsham, PA
National Provider Identifier
1336437276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MT200648
- Practice address
- 157 Upland Ave
Apt. a
Horsham, PA 19044-2616 - Phone
- (423) 967-9416
- NPI assigned
- Jul 13, 2011
- Last updated
- Jul 13, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MT200648 | PA | Primary |
Addresses
Primary practice location
157 Upland Ave
Apt. a
Horsham, PA 19044-2616
Mailing address
157 Upland Ave
Apt. a
Horsham, PA 19044-2616
Phone (423) 967-9416
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310515200000",
"number": "1336437276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 UPLAND AVE",
"address_2": "APT. A",
"city": "HORSHAM",
"state": "PA",
"postal_code": "190442616",
"telephone_number": "423-967-9416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "157 UPLAND AVE",
"address_2": "APT. A",
"city": "HORSHAM",
"state": "PA",
"postal_code": "190442616",
"telephone_number": "423-967-9416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHESTER",
"middle_name": "IRVIN",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-13",
"last_updated": "2011-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MT200648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Horsham, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.