Provider Demographics
NPI:1821036682
Name:CLARKE, CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 E. LANCASTER AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-649-3456
Mailing Address - Fax:610-642-1740
Practice Address - Street 1:300 E. LANCASTER AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-649-3456
Practice Address - Fax:610-642-1740
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032199E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29258Medicare UPIN
PA081399Medicare PIN