MEDICARE: DONALD KEITH CLARKE MD

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
1	207Q00000X	Family Medicine Physician	39571	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0150C	OTHER	NC	BLUE CROSS GROUP #
2	22787	OTHER	NC	BLUE CROSS INDIVIDUAL #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326138496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD KEITH CLARKE MD

Provider Business Mailing Address
First Line	:	1108 PARKWAY DR STE B
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9429
Country	:	US
Telephone Number	:	919-735-1251
Fax Number	:	919-734-5183

Provider Business Practice Location Address
First Line	:	1108 PARKWAY DR STE B
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9429
Country	:	US
Telephone Number	:	919-735-1251
Fax Number	:	919-734-5183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/17/2020

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