Provider Demographics
NPI:1104132190
Name:CLARKE, KILDARE (MD JD)
Entity type:Individual
Prefix:DR
First Name:KILDARE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HAZELTON DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3805
Mailing Address - Country:US
Mailing Address - Phone:914-949-9064
Mailing Address - Fax:
Practice Address - Street 1:6 HAZELTON DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3805
Practice Address - Country:US
Practice Address - Phone:914-949-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132990207PE0004X, 207Q00000X, 2083X0100X, 2084A0401X, 2084F0202X, 2084P0015X, 2084P2900X, 251B00000X, 261QM0801X, 282N00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No282N00000XHospitalsGeneral Acute Care Hospital
No305S00000XManaged Care OrganizationsPoint of Service