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General NPI Number Information
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NPI Number | 1528121753
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Entity Type | Individual
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Provider Name | MATTHEW ALAN THEOPHILUS CLARKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3051 36TH ST
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City | ASTORIA
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State | NY
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Zip | 11103-4704
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Country | US
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Telephone | 718-626-4444
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Fax | 718-949-9874
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | GREENVALE
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State | NY
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Zip | 11548-0280
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Country | US
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Telephone | 347-512-6200
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Fax | 516-407-2343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209612
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License Number State | NY
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