Provider Demographics
NPI:1861709495
Name:CLARKE, CARL L (RPA-C)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:L
Last Name:CLARKE
Suffix:
Gender:M
Credentials:RPA-C
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 300399
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-0399
Mailing Address - Country:US
Mailing Address - Phone:718-859-5237
Mailing Address - Fax:
Practice Address - Street 1:767 E 10TH ST
Practice Address - Street 2:2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2320
Practice Address - Country:US
Practice Address - Phone:718-859-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006336363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical