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

Clancy J Clark, MD

Individual provider Surgery Physician · NPI 1053455444

Clancy J Clark, MD is an Undefined Physician Type (Specify) in Seattle, Washington. Graduated from Ohio State University College of Medicine in 2004, 22 years ago. Practices with Virginia Mason Medical Center, a 867-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Carolina and Washington.

Years since qualifying
22
Trained at
Ohio State University College of Medicine
Licensed in
NC, WA
In the registry since
2007
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1100 9th Ave
Seattle, WA 98101
Phone: (206) 624-1144
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • Medical Center Blvd, Winston Salem, NC 27157-0001 — (336) 716-9272

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence MD61617432 (WA)
Surgery Physician Taxonomy 208600000X · Licence 2012-01216 (NC)
Surgical Oncology Physician Taxonomy 2086X0206X · Licence 2012-01216 (NC)

Record details

NPI number1053455444
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedFebruary 18, 2007
Last updated in NPPESDecember 13, 2024
Certification dateDecember 13, 2024
Mailing address2450 Greenbrier Rd, Winston Salem, NC 27104-2108

Medicare enrollment

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

Medicare specialtyUNDEFINED PHYSICIAN TYPE (SPECIFY)
Also practisesGENERAL SURGERY, SURGICAL ONCOLOGY
Medical schoolOHIO STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated 2004 (22 years in practice)
Group practice Virginia Mason Medical Center — 867 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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