Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles Clark

Individual provider Critical Care Medicine Registered Nurse · NPI 1265023535

Charles Clark is a Certified Registered Nurse Anesthetist (CRNA) in Baltimore, Maryland. Qualified in 2021, 5 years ago. Practices with Lifebridge Anesthesia Associates LLC, a 109-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Maryland and Pennsylvania.

Years since qualifying
5
Licensed in
MD, PA
In the registry since
2021
Specialties on file
3
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Practice location Address checks out

3001 S Hanover St
Baltimore, MD 21225-1233
Phone: (410) 350-3200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1701 Innovation Dr, York, PA 17408-8815 — (717) 843-8623

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence R217337 (MD)
Critical Care Medicine Registered Nurse Taxonomy 163WC0200X · Licence RN702962 (PA)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence RN702962 (PA)

Record details

NPI number1265023535
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 29, 2021
Last updated in NPPESJune 24, 2024
Certification dateJune 24, 2024
Mailing address1365 Old Westminster Rd, Westminster, MD 21157-6712

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Lifebridge Anesthesia Associates Llc — 109 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Baltimore