Provider Demographics
NPI:1265537864
Name:CLARKE, GARY KIRVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:KIRVEN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:VAMC NORTHPORT
Mailing Address - Street 2:79 MIDDLEVILLE RD
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-266-6015
Practice Address - Street 1:VAMC
Practice Address - Street 2:79 MIDDLEVILLE RD
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6015
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY181214-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology