SHANE CHAMBERLAIN CLARK (NPI# 1548495336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548495336 |
| Entity Type | Individual |
| Full Name | SHANE CHAMBERLAIN CLARK |
| Credential | M.D. |
| Practice Address |
5300 Far Hills Avenue Dayton OH 45429-2347 |
| Practice Telephone | 9374337536 |
| Practice Fax Number | 9374339612 |
| Mailing Telephone | 9374337536 |
| Mailing Fax Number | 9374339612 |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2016-08-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 35121081 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | ANTHEM BC/BS | 000000814530 | 01 |
| OH | AETNA | 9095975 | 01 |
| OH | CIGNA | 4098919 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972910305 | Shane Clark | Specialist/Technologist | 2151 Fews Chapel Rd, Greer, SC 29651-4946 | 2014-07-17 |
| 1003220203 | Shane Thomas Clark | Dentist | 2800 Coors Blvd Nw, Albuquerque, NM 87120-1204 | 2014-06-16 |
| 1437446440 | Shane Alexander Clark | Optometrist | 5734 Sheridan Lake Rd, Suite 202, Rapid City, SD 57702-8811 | 2011-06-29 |
| 1902391477 | Shane Clark | Student in an Organized Health Care Education/Training Program | 401 W Greenlawn Ave, Lansing, MI 48910-2819 | 2018-06-27 |
| 1265573067 | Shane Alan Clark | Anesthesiology | 6606 Lbj Fwy, Suite 200, Dallas, TX 75240-6533 | 2007-02-12 |
| Street Address |
5300 FAR HILLS AVENUE |
| City | DAYTON |
| State | OH |
| Zip Code | 45429-2347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689771933 | Shannon Michelle Novosad Verma | Dermatology | 5300 Far Hills Avenue, Dayton, OH 45429-2347 | 2006-09-20 |
| 1255580171 | Eugene Brent Kirkland | Dermatology | 5300 Far Hills Avenue, Dayton, OH 45429-2347 | 2008-09-16 |
| 1124274477 | Rocco Thomas Serrao | Dermatology | 5300 Far Hills Avenue, Dayton, OH 45429-2347 | 2008-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821576414 | Lauren Danielle Sivley | Nurse Practitioner | 3535 Sourthern Boulevard, Kettering, OH 45429 | 2018-08-06 |
| 1114446127 | Louai Al-samkari | Chiropractor | 1441 E. Stroop Rd., Kettering, OH 45429 | 2017-09-12 |
| 1407373756 | Benjamin Edward Adkins | Specialist/Technologist | 4116 Vinita Dr., Kettering, OH 45429 | 2017-08-28 |
| 1972036341 | James Kim | Student in an Organized Health Care Education/Training Program | 3535 Southern Boulevard, Kettering, OH 45429 | 2017-04-04 |
| 1023549847 | Adrienne Krysiak | Emergency Medicine | 3525 Southern Boulevard, Kettering, OH 45429 | 2017-03-23 |
| 1386021889 | Cassandra Mckoy | Counselor | 529 East Stroop Road, Kettering, OH 45429 | 2015-05-04 |
| 1417343088 | Candace Benoit | Obstetrics & Gynecology | 3533 Southern Blvd Ste 4600, Dayton, OH 45429 | 2015-04-10 |
| 1275933574 | Lee Schwieterman | Nurse Practitioner | 3535 Southern Blvd., 1 East, Kettering, OH 45429 | 2014-08-25 |
| 1497161947 | Robert Jonathon Fresch Jr. | Obstetrics & Gynecology | 3533 Southern Blvd Ste 3750, Kettering, OH 45429 | 2014-07-05 |
| 1821349812 | Lucas Brewer | Counselor | 1524 E Stroop Rd Ste 300, Kettering, OH 45429 | 2012-10-01 |
| Find all providers in zip 45429 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134362403 | Rishi Kumar Gandhi | Dermatology | 999 Brubaker Dr Ste 3, Dayton, OH 45429-3505 | 2009-04-15 |
| 1689771933 | Shannon Michelle Novosad Verma | Dermatology | 5300 Far Hills Avenue, Dayton, OH 45429-2347 | 2006-09-20 |
| 1689781395 | Samia W Borchers Md Inc | Dermatology | 5727 Far Hills Ave, Dayton, OH 45429 | 2006-08-25 |
| 1699880609 | Bruce A. Brumfiel | Dermatology | 4244 Indian Ripple Rd, Ste 300, Dayton, OH 45440-3279 | 2006-08-20 |
| 1801814272 | Rafael A. Perez-figaredo | Dermatology | 5300 Far Hills Ave., Dayton, OH 45429-2347 | 2006-07-17 |
| 1285689976 | Shalini Bahl | Dermatology | 8363 Yankee St, Dayton, OH 45458-1809 | 2006-05-23 |
| 1578552287 | Michael Ian Feldman | Dermatology | 30 Ashridge Rd., Dayton, OH 45419 | 2005-10-14 |
| 1023005261 | Thomas George Olsen | Dermatology | 7835 Paragon Rd, Dayton, OH 45459-4021 | 2005-10-03 |
| 1114920329 | Wright State Physicians Inc | Dermatology | 725 University Blvd, Dayton, OH 45435-0001 | 2005-05-23 |
| 1952940850 | Ohio Skin Surgery and Cosmetic Center | Dermatology | 999 Brubaker Dr Ste 3, Dayton, OH 45429-3505 | 2019-12-26 |
| Find all providers in DAYTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.