Provider Demographics
NPI:1548399603
Name:CLARKE, CHESTER CHATTERTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:CHATTERTON
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4901 TELSA DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4406
Mailing Address - Country:US
Mailing Address - Phone:301-464-4070
Mailing Address - Fax:301-464-4099
Practice Address - Street 1:4901 TELSA DR
Practice Address - Street 2:SUITE L
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4406
Practice Address - Country:US
Practice Address - Phone:301-464-4070
Practice Address - Fax:301-464-4099
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00458742083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine