Provider Demographics
NPI:1841254851
Name:CLARKE, KOFI (MD)
Entity type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
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:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-4950
Practice Address - Fax:717-531-6770
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060406L207RG0100X
PAMD 060406 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4175980-0001OtherCIGNA
PAP001620OtherGATEWAY HEALTH PLAN
PACL964338OtherHIGHMARK
PACL964338OtherPA BLUE CROSS/BLUE SHIELD
PA251879OtherUPMC HEALTH PLAN
PA001663170Medicaid
PA111399OtherUNISON HEALTH PLAN
PA0016631700008Medicaid
PA109978OtherGEISINGER HEALTH PLAN
PA110210402OtherRAILROAD MEDICARE
PA12230OtherBRAVO HEALTH
PA12230OtherBRAVO HEALTH
PA109978OtherGEISINGER HEALTH PLAN
G80693Medicare UPIN