Thomas W Clark, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

SC003084L Issued in PA

Practice address

918 Russell Dr
Lebanon, PA 17042-7485

Phone

(717) 273-3521

Fax

(717) 273-5172

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

Yes

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 PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lebanon Pain Relief Center PC

  • Pain Medicine (Anesthesiology) Physician
  • Lebanon, PA
  • NPI 1285903245
  NPD (past)

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1447251822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 RUSSELL DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427485",
            "telephone_number": "717-273-3521",
            "fax_number": "717-273-5172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 RUSSELL DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427485",
            "telephone_number": "717-273-3521",
            "fax_number": "717-273-5172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "THOMAS",
        "middle_name": "W",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC003084L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christy Joy Clark, BA
• Cody Clark
• David P. Clark, M.D.
• Joseph Martin Clark, M.D.
• Judith J Clark, LPC
• Bridgette Elizabeth Clarke, PSYD
• Leela A Cleary, AUD
• Thomas M Clemens, MD
• Kaila Alexis Clift, D.M.D.
• Cmu

• Podiatrist in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.