Provider Demographics
NPI:1326138496
Name:CLARKE, DONALD KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:KEITH
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 1:1108 PARKWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9429
Mailing Address - Country:US
Mailing Address - Phone:919-735-1251
Mailing Address - Fax:919-734-5183
Practice Address - Street 1:1108 PARKWAY DR STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9429
Practice Address - Country:US
Practice Address - Phone:919-735-1251
Practice Address - Fax:919-734-5183
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0150COtherBLUE CROSS GROUP #
NC22787OtherBLUE CROSS INDIVIDUAL #
NC8922787Medicaid
NC790150CMedicaid
NC22787OtherBLUE CROSS INDIVIDUAL #
NC2316260Medicare ID - Type UnspecifiedGROUP #
NC8922787Medicaid