DR. CHARLES EDWARD CLARK (NPI# 1609912427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609912427 |
| Entity Type | Individual |
| Full Name | DR. CHARLES EDWARD CLARK |
| Credential | MD |
| Practice Address |
74 Munsill Ave Suite 100 Bristol VT 05443-1032 |
| Practice Telephone | 8024535028 |
| Practice Fax Number | 8024536105 |
| Mailing Telephone | 8024535028 |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-09-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0420006979 | VT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | VT5630 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760940753 | Charles Patrick Clark | Physician Assistant | 6621 Fannin St, Houston, Houston, TX 77030 | 2019-03-08 |
| 1013485713 | Charles Nicholson Clark | Nurse Practitioner | 1331 Bandera Hwy Ste 4, Kerrville, TX 78028-9535 | 2018-11-12 |
| 1568971653 | Charles E Clark IIi | Counselor | 255 Main Street, St. Clairsville, OH 43950 | 2017-09-21 |
| 1649680406 | Charles Amos Clark | Internal Medicine | Vanderbilt University Dept of Medicine, D-3100, Medical Center North, Nashville, TN 37232 | 2014-05-02 |
| 1124301106 | Charles Malcolm Clark Jr. | Internal Medicine | 2802 Lafayette Road Suite 13, Eagledale Health Center, Indianapolis, IN 46222-2112 | 2011-09-26 |
| 1811290935 | Charles Warren Clark Jr. | Massage Therapist | 19577 Fm 2854 Rd, Montgomery, TX 77316-3150 | 2010-12-11 |
| 1780913640 | Charles S Clark | Physician Assistant | Bldg. H 2005 Knight Lane Attn: Medical Staff Services, Navy Medicine Support Command, Jacksonville, FL 92055-0140 | 2009-12-23 |
| 1083866222 | Charles Larry Clark Jr. | Dentist | 2415 Gillionville Rd, Albany, GA 31707-3022 | 2008-10-21 |
| 1689826984 | Charles John Clark | Pharmacist | 203 So. Daisy, Salmon, ID 83467 | 2008-10-17 |
| 1164642948 | Charles Robert Clark | Family Medicine | 1725 N Sky Glen Path, Hernando, FL 34442-6187 | 2007-04-26 |
| Street Address |
74 MUNSILL AVE SUITE 100 |
| City | BRISTOL |
| State | VT |
| Zip Code | 05443-1032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063401537 | Jeffrey S Wulfman | Family Medicine | 74 Munsill Ave, Suite 100, Bristol, VT 05443-1032 | 2005-10-18 |
| 1548528870 | Shawn R May | Social Worker | 74 Munsill Ave, Suite 100, Bristol, VT 05443-1032 | 2012-04-24 |
| 1194765396 | Suzanne Germain | Nurse Practitioner | 74 Munsill Ave, Suite 100, Bristol, VT 05443-1032 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124547344 | Amanda Elnora Knight | Occupational Therapist | 2555 Monkton Road, Bristol, VT 05443 | 2017-09-19 |
| 1841655289 | Michelle S. Davis | Speech-Language Pathologist | 220 Airport Drive, Mt. Abraham Union Middle/high School, Bristol, VT 05443 | 2015-12-30 |
| 1871840843 | Five-town Health Alliance, Inc | Family Medicine | 61 Pine Street, Building 4, Bristol, VT 05443 | 2012-08-09 |
| 1477855500 | Cassandra Corcoran | Counselor | 2722 Mountain Road, Bristol, VT 05443 | 2010-11-22 |
| 1427207182 | Chiropractic Health & Wellness PC | Chiropractor | 14 School St., Suite 105, Bristol, VT 05443 | 2008-09-17 |
| 1477756526 | Jennifer Ann Oxford | Occupational Therapist | 71 Mountain Street, Live Full Therapies LLC, Bristol, VT 05443 | 2007-06-07 |
| 1477685899 | Kenneth Schoen | Counselor | 802 Forge Hill Road, Lincoln, VT 05443 | 2007-03-12 |
| 1881747384 | Bristol Rescue Squad, Inc. | Ambulance | 45 Monkton Road, Bristol, VT 05443 | 2007-01-19 |
| 1730268103 | Diane K Greenberg | Physical Therapist | 167 Monkton Road, Suite 101b, Bristol, VT 05443 | 2006-11-04 |
| 1992800684 | Ann Dreher Fisher | Counselor | 14 School Street, Suite #9, Bristol, VT 05443 | 2006-09-14 |
| Find all providers in zip 05443 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871840843 | Five-town Health Alliance, Inc | Family Medicine | 61 Pine Street, Building 4, Bristol, VT 05443 | 2012-08-09 |
| 1417214537 | Leonard Davidson | Family Medicine | 202 Jefferson Ave, Bristol, PA 19007 | 2012-04-13 |
| 1760758734 | Renee Bratspis | Family Medicine | 74 Munsill Ave Ste 100, Bristol, VT 05443-1047 | 2012-03-23 |
| 1013288810 | Medical Education Assistance Corporation | Family Medicine | 826 Meadow View Rd, Bristol, TN 37620 | 2012-01-25 |
| 1780829572 | David Lynn Stevens | Family Medicine | 504 Old Jonesboro Rd, Bristol, TN 37620-5670 | 2008-12-08 |
| 1285892299 | Natasha Alexa Withers | Family Medicine | 61 Pine St Ste 400, Bristol, VT 05443-1043 | 2008-05-27 |
| 1992901409 | Uzoma N Obuekwe | Family Medicine | 2001 Euclid Ave, Bristol, VA 24201-3609 | 2007-06-22 |
| 1750502514 | Ronna Denise New | Family Medicine | 1 Medical Park Blvd Ste 450w, Bristol, TN 37620-7470 | 2007-05-01 |
| 1063552461 | Carol A Dewey | Family Medicine | 522 Alabama St, Bristol, TN 37620-2307 | 2007-02-07 |
| 1093898702 | J Scott Ries | Family Medicine | 504 Old Jonesboro Road, Bristol, TN 37620 | 2006-10-24 |
| Find all providers in BRISTOL | ||||
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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.