Individual ProviderJeanne M ClarkRadiologyAllopathic & Osteopathic PhysiciansPractice Address600 N Wolfe St, Baltimore, MD 21287-0005(410) 955-9434(410) 614-1135PECOS EnrollmentThis provider is enrolled in PECOS as JEANNE CLARK.Based on the most recent information from CMS, provider Jeanne M Clark is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1780636688Provider TypeIndividualFull NameClark, Jeanne MCredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date5/17/2006Last Updated5/14/2025Contact InformationPractice LocationPractice Address600 N Wolfe St, Baltimore, MD 21287-0005Phone(410) 955-9434FaxUnlisted FaxMailing LocationMailing AddressPO Box 64264, Baltimore, MD 21264-4264Phone(410) 614-1135FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense25MA08297800New JerseyCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseD52126MarylandProvider IdentifiersIDDescriptionIssuerID773500600DescriptionMedicaidIssuerUnlistedMaryland