Craig Charles Clark, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101037862 Issued in VA

Practice address

3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710

Phone

(703) 391-2020

Fax

(703) 391-1211

NPI assigned

Sep 9, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196380800000",
    "number": "1407840945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020",
            "fax_number": "703-391-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020",
            "fax_number": "703-391-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRAIG",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2007-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101037862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05622514",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Fairfax
• Clarity and Congruence Therapy, LLC
• Allison Kutner Clark, M.ED., BCBA
• Carrie Clark
• Ciara Clark
• Derek Ellis Clark, LCSW
• Gregory Clark
• John E Clark III
• Kaitlyn Clark
• Kevin Clark

• Family Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; 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.