Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kevin Clark, PA-C

Individual provider Physician Assistant · NPI 1790454726

Kevin Clark, PA-C is a Physician Assistant in Boston, Massachusetts. Qualified in 2021, 5 years ago. Practices with New York University, a 5,884-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2021
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

55 Fruit St
Boston, MA 02114-2696
Phone: (617) 724-4100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1790454726
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedSeptember 13, 2021
Last updated in NPPESOctober 12, 2021
Certification dateOctober 12, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice New York University — 5884 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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