Edward C. Clark,M.D.,P.a.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

D0017492 Issued in MD

Legal business name

EDWARD C. CLARK,M.D.,P.A.

Practice address

11355 Pembrooke SQ
Suite 107
Waldorf, MD 20603-4805

Phone

(301) 843-7711

Fax

(301) 932-9195

NPI assigned

Jul 29, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward C Clark, M.D.

Title

Owner

Phone

(301) 843-7711

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609876846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11355 PEMBROOKE SQ",
            "address_2": "SUITE 107",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034805",
            "telephone_number": "301-843-7711",
            "fax_number": "301-932-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11355 PEMBROOKE SQ",
            "address_2": "SUITE 107",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034805",
            "telephone_number": "301-843-7711",
            "fax_number": "301-932-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD C. CLARK,M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-843-7711",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0017492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Ophthalmology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.