Healthcare Provider Details

I. General information

NPI: 1972947059
Provider Name (Legal Business Name): CHRISTINA ELENA CLARKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ELENA PORTAL MD

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CHARTER DR STE 300
COLUMBIA MD
21044-3695
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 667-375-3376
  • Fax: 443-249-7437
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0088302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: