Provider Demographics
NPI:1427512698
Name:CLARKE, MILDRED IONA (MD)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:IONA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 ST. MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BKLYN N.Y.
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:718-759-1574
Mailing Address - Fax:
Practice Address - Street 1:COAHOMA TOWN HALL (CITY HALL)
Practice Address - Street 2:325 CHERRY ST CIRCLE 38617
Practice Address - City:COAHOMA MISS.
Practice Address - State:MS
Practice Address - Zip Code:38617
Practice Address - Country:US
Practice Address - Phone:662-337-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSV009.207V00000X
NY098478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology