Individual
DR. JENNIFER GRACE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 BREWSTER STREET, MEMORIAL HOSPITAL OF RHODE ISLAND, PAWTUCKET, RI 02860
(401) 729-3481
(401) 729-3866
Mailing address
111 BREWSTER STREET, MEMORIAL HOSPITAL OF RHODE ISLAND, PAWTUCKET, RI 02860
(401) 729-3481
(401) 729-3866
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD09743
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070589421
MEDICARE PTAN
RI
05
—
110087867A
—
MA
05
—
7058942
—
RI
Enumeration date
10/17/2006
Last updated
09/12/2011
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