Provider Demographics
NPI:1598734709
Name:CLARKE, ANDREA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-253-9132
Mailing Address - Fax:707-253-9178
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:707-253-9132
Practice Address - Fax:707-253-9178
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A660600OtherBLUE SHIELD PIN
CAZZZ66507ZOtherBLUE SHIELD GROUP PIN
CAZZZ03567ZMedicare PIN
CAH43740Medicare UPIN
CAZZZ66507ZOtherBLUE SHIELD GROUP PIN