Provider Demographics
NPI:1891491932
Name:CLARKE, RAGNAR JONAS (PA)
Entity Type:Individual
Prefix:
First Name:RAGNAR
Middle Name:JONAS
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 WASHINGTON BLVD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8813
Mailing Address - Country:US
Mailing Address - Phone:207-578-2390
Mailing Address - Fax:
Practice Address - Street 1:157 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6314
Practice Address - Country:US
Practice Address - Phone:914-248-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant