Provider Demographics
NPI:1225022551
Name:CLARK, TERRANCE P (MD)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:P
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8511
Mailing Address - Country:US
Mailing Address - Phone:828-586-5501
Mailing Address - Fax:828-586-3965
Practice Address - Street 1:91 TIMBERLANE DRIVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-7927
Practice Address - Country:US
Practice Address - Phone:828-454-1098
Practice Address - Fax:828-454-9242
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD348322084P0800X
NC202502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89064CVMedicaid
C83243Medicare UPIN
NC20732524BMedicare PIN
TN3860928Medicare ID - Type Unspecified