PAUL R CLARK; NPI #1851577795

Contact Information

PAUL R CLARK

1 BRAINTREE ST
ALLSTON, MA 02134-1602

Phone: 617-787-0504
Fax: 781-356-2074
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Customized Equipment	332BC3200X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for PAUL R CLARK

NPI Number 1851577795

LBN Legal business name PAUL R CLARK

Authorized official PAUL CLARK - (ORTHOTIST)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/10/2008

Last updated 10/29/2010 - About 16 years ago

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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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