Provider Demographics
NPI:1689709719
Name:CLARKE, DARYL ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:DARYL
Middle Name:ANDREW
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE119
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-805-5006
Mailing Address - Fax:301-805-5004
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE119
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-805-5006
Practice Address - Fax:301-805-5004
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18090225100000X
DC2800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3204256OtherAETNA
MD7910288OtherAETNA PPO
MDH853 0001OtherCAREFIRST DC
MD466223OtherMAMSI OPT CHOICE
MD686402-02OtherCAREFIRST
MDH853 0001OtherCAREFIRST DC