Provider Demographics
NPI:1477572436
Name:CLARKE, SUBHA T (MD)
Entity Type:Individual
Prefix:
First Name:SUBHA
Middle Name:T
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUBHA
Other - Middle Name:
Other - Last Name:THAMBUSWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:2344 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095
Practice Address - Country:US
Practice Address - Phone:413-596-3455
Practice Address - Fax:413-596-2961
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
691800OtherHARVARD PILGRIM
208627OtherTUFTS COMMUNITY HEALTH PL
MA0126373Medicaid
110230135OtherRR MEDICARE
1294015OtherFALLON COMMUNITY HEALTH P
983993OtherNETWORK HEALTH
208627OtherCONNECTICARE
4487076OtherHEALTHSOURCE CMHC
J23473OtherBLUE CROSS BLUE SHIELD
B10496101OtherCIGNA
110230135OtherRR MEDICARE
G34990Medicare UPIN