Provider Demographics
NPI:1164664090
Name:CLARK, PAIGE DAVIS (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:DAVIS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5237
Mailing Address - Country:US
Mailing Address - Phone:252-633-3942
Mailing Address - Fax:252-636-8418
Practice Address - Street 1:801 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5237
Practice Address - Country:US
Practice Address - Phone:252-633-3942
Practice Address - Fax:252-633-3332
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCD421AMedicare PIN