DR. RYAN STEWART CLARK D.O. NPI 1396049011

NPI Information

NPI: 1396049011
Provider Name: DR. RYAN STEWART CLARK, D.O.
Classification: Internal Medicine - 207RC0000X
Entity Type: Individual

Specialization: Cardiovascular Disease

Organization: ALLIANCE PHYSICIANS INC

PECOS Registration: Yes

Address:
1380 E STROOP RD
KETTERING, OH
ZIP 45429
Phone: (937) 293-3486
Get Directions

DR. Ryan Stewart Clark, D.O. is a cardiovascular disease internal medicine in Kettering, OH with 14 years of experience. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. DR. Ryan Stewart Clark, D.O. NPI is 1396049011. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: NOVA SOUTHEASTERN UNIV COLLEGE OF DENTAL MEDICINE
Graduation Year:2010

The provider's business location address is:

1380 E STROOP RD
KETTERING, OH
ZIP 45429-926
Phone: (937) 293-3486
Fax: (937) 293-3605

The NPI 1396049011 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 1/10/2011 and was last updated on 1/28/2021.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		34010728	OHIO	No
2	207RC0000X	Internal Medicine	Cardiovascular Disease	34010728	OHIO	Yes
3	390200000X	Student in an Organized Health Care Education/Training Program		58.003689	OHIO	No

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0100097	MEDICAID	OHIO

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: 11/14/2023

NPI Synchronization or Removal

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