Individual
MAUREEN P. CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1000
(617) 421-6084
Mailing address
147 MILK ST, PROVIDER ENROLLMENT DEPARTMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
48912
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027086
NEIGHBORHOOD HEALTH
MA
01
—
048912
TUFTS HEALTH PLAN
MA
01
—
1501845-003
CIGNA
MA
05
—
6170277
—
MA
01
—
J02335
BLUE CROSS BLUE SHIELD
MA
01
—
P00074198
P00074198
MA
Enumeration date
04/26/2006
Last updated
01/05/2012
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