Provider Demographics
NPI:1467528737
Name:CLARKE, JAMES LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LINCOLN
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 1:43 WHITING HILL RD
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST STE 330
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6638
Practice Address - Country:US
Practice Address - Phone:207-973-8881
Practice Address - Fax:207-973-8880
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18046208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72D931Medicare ID - Type Unspecified
NYB79126Medicare UPIN