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NPI Code Detail

MEDICARE: MARCIA CAROLINE CLARKE-PENNANT

MEDICARE: MARCIA CAROLINE CLARKE-PENNANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner249451APGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1999999999999OTHERGADO NOT HAVE A NPI NUMBER

General Provider Information

NPI Number : 1215441092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIA CAROLINE CLARKE-PENNANT
Provider Business Mailing Address
First Line : 4770 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10470-1104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12 TIBBITS AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10606-2438
Country : US
Telephone Number : 914-287-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2017
Last Update Date : 05/24/2019

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Directions to “ MARCIA CAROLINE CLARKE-PENNANT ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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