Provider Demographics
NPI:1346341062
Name:CARTHRAE, CLARK LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:LEWIS
Last Name:CARTHRAE
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 1:1227 ASHLEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3383
Mailing Address - Country:US
Mailing Address - Phone:270-781-1354
Mailing Address - Fax:270-781-7308
Practice Address - Street 1:1227 ASHLEY CIRCLE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3383
Practice Address - Country:US
Practice Address - Phone:270-781-1354
Practice Address - Fax:270-781-7308
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16213208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64162134Medicaid
KY64162134Medicaid
1085001Medicare ID - Type Unspecified