DAVID GLENN CLARK MD NPI 1790728459

NPI Information

NPI: 1790728459
Provider Name: DAVID GLENN CLARK, MD
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Individual

Specialization: Neurology

PECOS Registration: Yes

Address:
171 ASHLEY AVE
CHARLESTON, SC
ZIP 29425
Phone: (843) 792-1414
Get Directions

David Glenn Clark, MD is a neurology psychiatry neurology in Charleston, SC with 30 years of experience. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. David Glenn Clark, MD NPI is 1790728459. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Graduation Year:1994

The provider's business location address is:

171 ASHLEY AVE
CHARLESTON, SC
ZIP 29425-908
Phone: (843) 792-1414

The NPI 1790728459 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 6/13/2006 and was last updated on 6/27/2014.

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	2084N0400X	Psychiatry & Neurology	Neurology	21639	ALABAMA	No
2	2084N0400X	Psychiatry & Neurology	Neurology	37037	SOUTH CAROLINA	Yes

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	009932394	MEDICAID	ALABAMA
2	051556422	MEDICARE PIN	ALABAMA
3	P00313093	OTHER		RAILROAD MEDICARE
4	051529987	OTHER	ALABAMA	BLUE CROSS
5	051529988	OTHER	ALABAMA	BLUE CROSS
6	009932389	MEDICAID	ALABAMA
7	G82404	OTHER	ALABAMA	VIVA

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

NPI Synchronization or Removal

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