Provider Demographics
NPI:1902616311
Name:IDELKOPE, CLARE
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:IDELKOPE
Suffix:
Gender:F
Credentials:
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 286
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:NH
Mailing Address - Zip Code:03750-0286
Mailing Address - Country:US
Mailing Address - Phone:603-306-6731
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 286
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:NH
Practice Address - Zip Code:03750-0286
Practice Address - Country:US
Practice Address - Phone:603-306-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant