Provider Demographics
NPI:1467811133
Name:ROHAN CLARKE MD PA
Entity Type:Organization
Organization Name:ROHAN CLARKE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-200-1410
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-1362
Mailing Address - Country:US
Mailing Address - Phone:347-200-1410
Mailing Address - Fax:817-732-8015
Practice Address - Street 1:500 THROCKMORTON ST
Practice Address - Street 2:3107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3708
Practice Address - Country:US
Practice Address - Phone:347-200-1410
Practice Address - Fax:817-732-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8608207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty