Jeannine Avis Clark, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D0043862 Issued in MD

Practice address

6915 Laurel Bowie Road
Suite 301
Bowie, MD 20715

Phone

(301) 249-8838

Fax

(301) 249-5334

NPI assigned

Jun 28, 2006

Sex

Female

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 MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1457389892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6915 LAUREL BOWIE ROAD",
            "address_2": "SUITE 301",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20715",
            "telephone_number": "301-249-8838",
            "fax_number": "301-249-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6915 LAUREL BOWIE ROAD",
            "address_2": "SUITE 301",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20715",
            "telephone_number": "301-249-8838",
            "fax_number": "301-249-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEANNINE",
        "middle_name": "AVIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0043862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Drogin Citrenbaum
• City Wide Treatment Center
• Amanda Lyne Clark, MSW, LCSW-C
• Britney Renee Clark
• Grace D. Clark, PH.D.
• Chester Chatterton Clarke, MD
• Osei Clarke, D.D.S
• Nakeisha Clash
• Bobga Clauman
• Clear Expressions Therapeutic Services

• Pediatrics Physician in Bowie, MD
• Providers in Bowie, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.