Dr. Susan Christine Clark, MD
Surgery in Portsmouth, VA. Individual provider (NPI-1).
NPI number1104096650
StatusActive
Last updated in NPPESFeb 20, 2024
Details
- NPI
- 1104096650
- Entity type
- Individual (NPI-1)
- Name
- Dr. Susan Christine Clark
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 11, 2008
- Certification date
- Feb 16, 2024
- Last updated
- Feb 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | 0101253279 | VA | Yes |
| 208600000X | Surgery | 2011-00718 | NC | |
| 208600000X | Surgery | MD426779 | PA |
Practice location
Naval Medical Center Portsmouth620 John Paul Jones Circle
Portsmouth, VA 23708
Phone 757-953-9759 · Fax 757-953-0845
Mailing address
Naval Medical Center Portsmouth620 John Paul Jones Circle
Portsmouth, VA 23708-9971
Phone 757-953-9759
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