Provider Demographics
NPI:1376731034
Name:CLARKE-BENNETT, KAREN S (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:CLARKE-BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:1222
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-7571
Mailing Address - Country:US
Mailing Address - Phone:410-672-2700
Mailing Address - Fax:410-672-2707
Practice Address - Street 1:1114 TOWN CENTER BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:410-672-2700
Practice Address - Fax:410-672-2707
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH0066498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150610ZDDB - 149619Medicare PIN
MD945LR720Medicare PIN