Provider Demographics
NPI:1265487839
Name:ANDREWS, CLARKE B (MD)
Entity Type:Individual
Prefix:
First Name:CLARKE
Middle Name:B
Last Name:ANDREWS
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 1:36 BOTETOURT RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-4199
Mailing Address - Country:US
Mailing Address - Phone:540-473-2110
Mailing Address - Fax:540-473-2723
Practice Address - Street 1:36 BOTETOURT RD
Practice Address - Street 2:
Practice Address - City:FINCASTLE
Practice Address - State:VA
Practice Address - Zip Code:24090-4199
Practice Address - Country:US
Practice Address - Phone:540-473-2110
Practice Address - Fax:540-473-2723
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005622000Medicaid
VA080007745Medicare ID - Type UnspecifiedPROVIDER ID
VAB06262Medicare UPIN