Provider Demographics
NPI:1326090911
Name:CLARKE, TERENCE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:JOSEPH
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 GROOMS RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1305
Mailing Address - Country:US
Mailing Address - Phone:518-859-8271
Mailing Address - Fax:
Practice Address - Street 1:7 SOUTHWOODS BLVD STE 17
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2564
Practice Address - Country:US
Practice Address - Phone:518-641-6580
Practice Address - Fax:518-292-6088
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY222853208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11323390OtherCAQH
NY3715H1OtherBLUE CROSS
NY7370593OtherAETNA
NY000000072573OtherGHI-HMO
NY000415749001OtherBLUE SHIELD
NY10088694OtherCDPHP
NY7515N2OtherBLUE CROSS
NY050127000002OtherFIDELIS
NY5996001OtherGHIPPO
NY782956OtherMVP
NY5996001OtherGHI_PPO
NY7370593OtherAETNA
NY3715H1OtherBLUE CROSS