Provider Demographics
NPI:1891759817
Name:CLARKE, DANIEL H (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:CLARKE
Suffix:
Gender:M
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:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8837
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:2121 MEDICAL PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4054
Practice Address - Country:US
Practice Address - Phone:301-681-4422
Practice Address - Fax:301-681-1684
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00638032085R0203X
VA01010460182085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1172517OtherAETNA HMO
MD60332702OtherCAREFIRST BC/BS
MD158895OtherPHCS
MD219441401Medicaid
MD296135OtherAMERIGROUP
MD1620115OtherCIGNA
DC2906-0016OtherCAREFIRST BC/BS
MD4828OtherELDER HEALTH
DC037461100Medicaid
MD4230117OtherAETNA PPO
MD503862OtherNATIONAL CAPITOL PPO
MD60332702OtherCAREFIRST BC/BS
MD503862OtherNATIONAL CAPITOL PPO