Individual
TERENCE JOSEPH CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7 SOUTHWOODS BLVD STE 17, ALBANY, NY 12211-2564
(518) 641-6580
(518) 292-6088
Mailing address
893 GROOMS RD, REXFORD, NY 12148-1305
(518) 859-8271
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
222853
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000072573
GHI-HMO
NY
01
—
000415749001
BLUE SHIELD
NY
01
—
050127000002
FIDELIS
NY
01
—
10088694
CDPHP
NY
01
—
11323390
CAQH
NY
01
—
3715H1
BLUE CROSS
NY
01
—
5996001
GHIPPO
NY
01
—
7370593
AETNA
NY
01
—
7515N2
BLUE CROSS
NY
01
—
782956
MVP
NY
Enumeration date
05/16/2006
Last updated
03/27/2023
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