Provider Demographics
NPI:1952756652
Name:MARK E CLARKE,NP,LLC
Entity type:Organization
Organization Name:MARK E CLARKE,NP,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:401-349-4303
Mailing Address - Street 1:600 PUTNAM PIKE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1486
Mailing Address - Country:US
Mailing Address - Phone:401-349-4303
Mailing Address - Fax:401-349-4373
Practice Address - Street 1:600 PUTNAM PIKE
Practice Address - Street 2:SUITE 8
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1486
Practice Address - Country:US
Practice Address - Phone:401-349-4303
Practice Address - Fax:401-349-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-30
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP34239Medicare UPIN