Provider Demographics
NPI:1245269562
Name:CLARKE, ASHLEY WILLIAMS (DO)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:WILLIAMS
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WALES AVE NW # 220
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2310
Mailing Address - Country:US
Mailing Address - Phone:330-880-5671
Mailing Address - Fax:330-880-5781
Practice Address - Street 1:2520 WALES AVE NW # 220
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2310
Practice Address - Country:US
Practice Address - Phone:330-880-5671
Practice Address - Fax:330-880-5781
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007798C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000375429OtherUNICARE PROVIDER #
OH733389OtherBUCKEYE HEALTH PLAN
OH1062OtherSUMMACARE PROVIDER #
OH200830551029OtherCARESOURCE PROVIDER #
OH000000375429OtherBCBS PROVIDER #
OH2622344Medicaid
OHI43612Medicare UPIN
OH2622344Medicaid