Provider Demographics
NPI:1205863065
Name:CLARKE, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CLARKE
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 1:6565 FOURTH SECTION ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420
Mailing Address - Country:US
Mailing Address - Phone:585-637-2670
Mailing Address - Fax:585-637-3678
Practice Address - Street 1:6565 FOURTH SECTION ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-637-2670
Practice Address - Fax:585-637-3678
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000917573006OtherHEALTH NOW
5685086OtherAETNA
106154CKOtherPREFERRED CARE
NY02120381Medicaid
0296748OtherGHI
NY02120381Medicaid
0296748OtherGHI