Provider Demographics
NPI:1386868537
Name:CLARKE, JOHN DEIGHTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEIGHTON
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-248-3410
Mailing Address - Fax:516-248-3419
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-248-3410
Practice Address - Fax:516-248-3419
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY215688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine