Provider Demographics
NPI:1912966003
Name:BROWN, CLARKE DOUGLAS (PT,ATC,DPT)
Entity Type:Individual
Prefix:DR
First Name:CLARKE
Middle Name:DOUGLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT,ATC,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 KIPP RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8312
Mailing Address - Country:US
Mailing Address - Phone:585-396-3344
Mailing Address - Fax:
Practice Address - Street 1:1900 ROUTE 31
Practice Address - Street 2:WEST WAYNE PLAZA
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8943
Practice Address - Country:US
Practice Address - Phone:315-986-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01684335Medicaid
NY14239AMedicare ID - Type Unspecified
NY14239BMedicare PIN