Basic Information
| Provider Information | |||||||||
| NPI: | 1093971947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARKE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | NICHOLSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144458039 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155301229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142674603 | ||||||||
| FaxNumber: | 8142676467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5908 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS017576 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.