1477572436 NPI number — SUBHA T CLARKE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477572436 NPI number — SUBHA T CLARKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARKE
Provider First Name:
SUBHA
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THAMBUSWAMY
Provider Other First Name:
SUBHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477572436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WRIGHT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-283-7651
Provider Business Mailing Address Fax Number:
413-284-5117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2344 BOSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBRAHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-596-3455
Provider Business Practice Location Address Fax Number:
413-596-2961
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  208627 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 691800 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208627 . This is a "TUFTS COMMUNITY HEALTH PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0126373 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110230135 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1294015 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 983993 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208627 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4487076 . This is a "HEALTHSOURCE CMHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23473 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: B10496101 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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