Charles Edward Clark, MD – Family Medicine Physician

Key facts

NPI: 1609912427
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 0420006979 (VT)
Practice address: 74 Munsill Ave
Suite 100
Bristol, VT 05443-1032
Phone: (802) 453-5028
Fax: (802) 453-6105
NPI assigned: Jan 29, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Mountain Health Center Family Medicine Physician · Bristol, VT · NPI 1003939463

NPD (past) FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Mountain Health Center	Family Medicine	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	0420006979	VT	Yes

Addresses

Primary practice location

74 Munsill Ave
Suite 100
Bristol, VT 05443-1032

Mailing address

74 Munsill Ave
Suite 100
Bristol, VT 05443-1032
Phone (802) 453-5028

Other identifiers

Identifier	Type	State	Issuer
VT5630	Medicaid	VT

Other providers in Bristol, VT

All providers in Bristol, VT · Family Medicine Physician in Vermont

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.