Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 132990 | NY |
N | 207Q00000X | Family Doctor | 132990 | NY |
NPI | 1104132190 |
---|---|
Provider Name | Dr. Kildare Clarke |
First Address | White Plains, NY 10605-3805 |
Second Address | White Plains, NY 10605-3805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2010 |
Last Update Date | 27/08/2010 |