Individual
DR. GREGORY D CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4522 MACCORKLE AVE, SE, SUITE 3, CHARLESTON, WV 25314
(304) 720-7305
(304) 720-7310
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 347-1290
(304) 347-1397
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16242
WV
207R00000X
Internal Medicine Physician
16242
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110526000
—
WV
Enumeration date
09/20/2006
Last updated
10/08/2014
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