Provider Demographics
NPI:1518429687
Name:CLARK, ISAIAH JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:JAMES
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 1:751 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2591
Mailing Address - Country:US
Mailing Address - Phone:814-333-5000
Mailing Address - Fax:
Practice Address - Street 1:765 LIBERTY ST STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-373-3434
Practice Address - Fax:814-373-5152
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD489887208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program