Provider Demographics
NPI:1871690685
Name:CLARKE, MARTHA R (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:R
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 1:5727 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3707
Mailing Address - Country:US
Mailing Address - Phone:412-363-6626
Mailing Address - Fax:412-363-7008
Practice Address - Street 1:5727 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3707
Practice Address - Country:US
Practice Address - Phone:412-363-6626
Practice Address - Fax:412-363-7008
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025515E207ZC0500X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000117134OtherUNISON
1517938OtherGATEWAY HEALTH PLAN
PA001107OtherHIGHMARK BLUE SHIELD
202350OtherUPMC HEALTH PLAN
2993748OtherAETNA
P00000601OtherRAILROAD MEDICARE
PA0009538540005Medicaid
PA0009538540005Medicaid
PA001107Medicare PIN