Provider Demographics
NPI:1801191077
Name:CLARKE, BETH
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 LIMEKILN PIKE
Mailing Address - Street 2:SUITE C-106
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2601
Mailing Address - Country:US
Mailing Address - Phone:215-881-2290
Mailing Address - Fax:215-881-2293
Practice Address - Street 1:8460 LIMEKILN PIKE
Practice Address - Street 2:SUITE C-106
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2601
Practice Address - Country:US
Practice Address - Phone:215-881-2290
Practice Address - Fax:215-881-2293
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist