Individual
GREGORY CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2123 AUBURN AVE, SUITE 138, CINCINNATI, OH 45219-2906
(513) 206-1120
(512) 206-1122
Mailing address
237 WILLIAM HOWARD TAFT RD, 2ND FLOOR, CBO 2-3, CINCINNATI, OH 45219-2610
(513) 206-1120
(513) 206-1122
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35069414
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215174
ANTHEM
—
01
—
0659341
AETNA
—
05
—
200076710
—
IN
01
—
25-20465
UNITED
—
01
—
263070266
CARESOURCE
OH
01
—
283291
AMERIGROUP MEDICAID
—
01
—
311438871044
CARESOURCE MEDICAID
—
05
—
64298508
—
KY
05
—
64298508
—
OH
01
—
69414-01
HUMANA
—
01
—
P00222905
RAILROAD MEDICARE
OH
Enumeration date
12/30/2005
Last updated
10/21/2020
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