National Provider Identifier Database

PAUL R CLARK
Customized Equipment


Contact Information

PAUL R CLARK
1 BRAINTREE ST
ALLSTON, MA02134-1602
Phone: 617-787-0504
Fax: 781-356-2074
Website:
Specialty Taxonomy Code
* Customized Equipment 332BC3200X

* Indicates primary specialty

NPI Profile & details for PAUL R CLARK

NPI Number 1851577795
Legal business name
LBN
PAUL R CLARK
Authorized official PAUL CLARK - (ORTHOTIST)
Entity Organization
Organization subpart No
Enumeration date 01/10/2008
Last updated 10/29/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers
  • MA Medicaid: 1537369
  • MA Other: 375354 BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS
  • MA Other: 670375 TUFT'S HEALTH INSURANCE
  • MA Other: 670375 TUFT'S NAVIGATOR
  • MA Other: 670375 TUFT'S TOTAL HEALTH PLAN

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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