Provider Demographics
NPI:1750532214
Name:CLARKE, CYNTHIA E (DO, RD)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:E
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DO, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BACKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3127
Mailing Address - Country:US
Mailing Address - Phone:585-414-4722
Mailing Address - Fax:
Practice Address - Street 1:31 BACKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-3127
Practice Address - Country:US
Practice Address - Phone:585-414-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CT641432085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered