Healthcare Provider Details

I. General information

NPI: 1215433842
Provider Name (Legal Business Name): LINSEY CLARKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTH CENTER DR
BRIDGEWATER VA
22812-9511
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-2634
  • Fax: 540-828-6911
Mailing address:
  • Phone: 540-224-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102206600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: