Provider Demographics
NPI:1669909677
Name:CLARKE, BRIAN H JR (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:CLARKE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:993 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3644
Mailing Address - Country:US
Mailing Address - Phone:860-836-5438
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 919
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5528
Practice Address - Country:US
Practice Address - Phone:860-696-5533
Practice Address - Fax:860-522-3951
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical