Provider Demographics
NPI:1568423168
Name:CLARKE, DESIREE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3810 NORTHDALE BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:775 MAIN ST S
Practice Address - Street 2:UNIT 220/230
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2271
Practice Address - Country:US
Practice Address - Phone:203-405-7148
Practice Address - Fax:203-405-7149
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT49003202K00000X, 207V00000X
FLME151858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTDR2994Medicare PIN
CTD400037368Medicare PIN
CTP00918492Medicare PIN
CTD100037356Medicare PIN