Provider Demographics
NPI:1649279555
Name:CLARKE, PAUL D (PA-C)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:CLARKE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PINNACLE BEHAVIORAL HEALTH, IPA, LLC
Mailing Address - Street 2:1 PINNACLE PLACE SUITE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-689-0244
Mailing Address - Fax:518-689-0241
Practice Address - Street 1:PINNACLE BEHAVIORAL HEALTH, IPA, LLC
Practice Address - Street 2:1 PINNACLE PLACE SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-689-0244
Practice Address - Fax:518-689-0241
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2021-03-31
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Provider Licenses
StateLicense IDTaxonomies
NY1679-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR56722Medicare UPIN
NYPA0699Medicare ID - Type Unspecified