Provider Demographics
NPI:1699912204
Name:CLARKE, TERRY H (DPM)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:H
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FLOWERS DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1709
Mailing Address - Country:US
Mailing Address - Phone:717-620-8225
Mailing Address - Fax:
Practice Address - Street 1:4 FLOWERS DR
Practice Address - Street 2:SUITE #2
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1709
Practice Address - Country:US
Practice Address - Phone:717-620-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005924213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102292408Medicaid
PA102292408Medicaid