Provider Demographics
NPI:1356511992
Name:CLARKE, CLARENCE GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:GEORGE
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 CANON BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2554
Mailing Address - Country:US
Mailing Address - Phone:757-599-4922
Mailing Address - Fax:757-599-4927
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-599-4922
Practice Address - Fax:757-599-4927
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202186207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine