DR. CHARLES MALCOLM CLARK JR. (NPI# 1124301106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124301106 |
| Entity Type | Individual |
| Full Name | DR. CHARLES MALCOLM CLARK JR. |
| Credential | MD |
| Practice Address |
2802 Lafayette Road Suite 13 Eagledale Health Center Indianapolis IN 46222-2112 |
| Practice Telephone | 3179237510 |
| Practice Fax Number | 3179237518 |
| Mailing Telephone | 3179237510 |
| Mailing Fax Number | 3179237518 |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2011-09-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
01020086A | IN | Allopathic & Osteopathic Physicians |
| 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 |
| 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 |
| 1093722902 | Charles Kevin Clark | Physical Therapist | 10214 N Tatum Blvd, Suite B-500, Phoenix, AZ 85028-4224 | 2006-08-02 |
| Street Address |
2802 LAFAYETTE ROAD SUITE 13 EAGLEDALE HEALTH CENTER |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46222-2112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871194472 | Megan Mccullough | Pharmacist | 10617 East Washington Street, Pharmacy At Walmart, Indianapolis, IN 46222 | 2020-11-02 |
| 1215401450 | Resilient Services | Counselor | 3519 W Michigan Street, Indianapolis, IN 46222 | 2019-01-21 |
| 1376925487 | Ossama Elbarawy | Dentist | 2410 W. 17th St, Indianapolis, IN 46222 | 2015-06-25 |
| 1780025163 | Suzy Q Service Cororation | Chore Provider | 2401 N Tibbs Ave, Indianapolis, IN 46222 | 2013-07-12 |
| 1952607939 | Monica Lee Mcmullen | Dietitian, Registered | 2732 West Michigan St., Westside Health Center, Indianapolis, IN 46222 | 2011-02-08 |
| 1306082318 | Jose Fanor Melendez | Psychiatry & Neurology | 3422 N. Taft Av, Indianapolis, IN 46222 | 2008-12-22 |
| 1861693277 | David Hazra | Preventive Medicine | 340 S. White River Parkway, Indianapolis, IN 46222 | 2007-05-31 |
| 1528191467 | Rem Indiana | Intermediate Care Facility, Mentally Retarded | 3025 Green Hills Lane, Indianapolis, IN 46222 | 2007-03-13 |
| 1366589467 | Indianapolis Osteopathic Hospital Inc. | Podiatrist | 3520 Guion Rd Suite 204, Indianapolis, IN 46222 | 2007-01-30 |
| 1508919077 | Ronald L. Gemma | Family Medicine | 3750 Guion Rd., Ste. 185, Indianapolis, IN 46222 | 2007-01-19 |
| Find all providers in zip 46222 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679080683 | Gregory Alan Gaich | Internal Medicine | 5891 N New Jersey St, Indianapolis, IN 46220-2534 | 2017-12-29 |
| 1154833002 | Endocrinology & Diabetes of Indiana LLC | Internal Medicine | 9240 N Meridian St Ste 240, Indianapolis, IN 46260-1876 | 2017-11-01 |
| 1669909388 | Primariahealth, PC | Internal Medicine | 9365 Counselors Row Ste 210, Indianapolis, IN 46240-6418 | 2017-05-11 |
| 1083078943 | James K Malone | Internal Medicine | 5256 N Illinois St, Indianapolis, IN 46208-2636 | 2016-04-07 |
| 1891920914 | Anne Caroline Kitchens | Internal Medicine | 8435 Clearvista Pl Ste 101, Indianapolis, IN 46256 | 2009-05-19 |
| 1790941383 | Louis Vignati | Internal Medicine | 8515 Olde Mill Circle West Dr, Indianapolis, IN 46260-2372 | 2008-08-03 |
| 1992960140 | Janet Tobian | Internal Medicine | 9121 Walnut Grove Dr, Indianapolis, IN 46236-8533 | 2008-07-26 |
| 1376684993 | Eugene Henry Lamkin Jr. | Internal Medicine | 4145 Washington Blvd, Indianapolis, IN 46205-2616 | 2007-02-08 |
| 1639192743 | Andrew Cagle | Internal Medicine | 7310 Preamble Ct, Indianapolis, IN 46259-5751 | 2006-07-26 |
| 1578586681 | Rashid Khairi | Internal Medicine | 7501 N Pennsylvania St, Indianapolis, IN 46240-2801 | 2006-07-26 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46222 |
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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.