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DR. MARY ELIZABETH REVILLA CLARK M.D. NPI 1225109770


NPI Information

NPI: 1225109770
Provider Name: DR. MARY ELIZABETH REVILLA CLARK, M.D.
Classification: Internal Medicine - 207RG0100X
Entity Type: Individual

Specialization: Gastroenterology

PECOS Registration: Yes

Address:
2333 BUCHANAN ST
SUITE 5823
SAN FRANCISCO, CA
ZIP 94115
Phone: (415) 644-5752
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DR. Mary Elizabeth Revilla Clark, M.D. is a gastroenterology internal medicine in San Francisco, CA. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. DR. Mary Elizabeth Revilla Clark, M.D. NPI is 1225109770. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2333 BUCHANAN ST
SUITE 5823
SAN FRANCISCO, CA
ZIP 94115-925
Phone: (415) 644-5752

The NPI 1225109770 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/13/2006 and was last updated on 1/13/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0100XInternal MedicineGastroenterologyA98304CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1MD-12890OTHERHAWAIIHAWAII MEDICAL LICENSE
2A98304OTHERCALIFORNIACALIFORNIA STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.