SETH CLARK (NPI# 1801208798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801208798 |
| Entity Type | Individual |
| Full Name | SETH CLARK |
| Practice Address |
200 Corliss St Providence RI 02904 |
| Mailing Address |
117 Ellenfield St Ste 101 Providence RI 02905-4513 |
| Practice Telephone | 4016068530 |
| Practice Fax Number | 4016068549 |
| Mailing Telephone | 4014446779 |
| Mailing Fax Number | 4014446912 |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2019-07-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MD15837 | RI | Allopathic & Osteopathic Physicians |
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
MD15837 | RI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 Corliss St, Providence, RI 02904 | 4016068530 | 4016068549 |
| 593 Eddy St, Providence, RI 029034923 | 4014444741 | 4014444445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184908444 | Seth Benjamin Clark | Behavioral Analyst | 1920 Briarcliff Road, Atlanta, GA 30329 | 2011-10-05 |
| 1619577418 | Seth C Clark | Pharmacist | 1632 N 2000 W, Clinton, UT 84015-8367 | 2020-10-30 |
| 1669811915 | Seth Clark | Podiatrist | 4550 E Bell Rd Ste 170, Phoenix, AZ 85032 | 2013-06-20 |
| Street Address |
200 CORLISS ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
| 1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
| 1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
| 1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
| 1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
| 1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
| 1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
| 1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
| 1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
| 1114243599 | Occupational Health Services of The Southwest Pa | Clinic/Center | 290 Branch Ave, Providence, RI 02904 | 2010-04-11 |
| Find all providers in zip 02904 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760977136 | Prospect Chartercare Rwmc, LLC | Internal Medicine | 825 Chalkstone Ave, Providence, RI 02908-4728 | 2018-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386626174 | Denis E Moonan Jr. | Internal Medicine | 1515 Smith St, Suite N, North Providence, RI 02911-2947 | 2005-11-16 |
| 1821656034 | Prospect Chartercare Sjhsri, LLC | Internal Medicine | 200 High Service Ave, N Providence, RI 02904-5113 | 2019-06-03 |
| 1508049305 | Medical Assisted Recovery, Inc. | Internal Medicine | 875 Centerville Rd, Warwick, RI 02886-4381 | 2007-12-14 |
| 1538108857 | Andrew C Stone | Internal Medicine | 111 Howard Ave, Cranston, RI 02920-3001 | 2006-06-05 |
| City | PROVIDENCE |
| Zip Code | 02904 |
Please comment or provide details below to improve the information on SETH CLARK.
| 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.