Basic Information
| Provider Information | |||||||||
| NPI: | 1477572436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARKE | ||||||||
| FirstName: | SUBHA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THAMBUSWAMY | ||||||||
| OtherFirstName: | SUBHA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132837651 | ||||||||
| FaxNumber: | 4132845117 | ||||||||
| Practice Location | |||||||||
| Address1: | 2344 BOSTON RD | ||||||||
| Address2: | |||||||||
| City: | WILBRAHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135963455 | ||||||||
| FaxNumber: | 4135962961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 208627 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 691800 | 01 | HARVARD PILGRIM | OTHER | 208627 | 01 | TUFTS COMMUNITY HEALTH PL | OTHER | 0126373 | 05 | MA | MEDICAID | 110230135 | 01 | RR MEDICARE | OTHER | 1294015 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 983993 | 01 | NETWORK HEALTH | OTHER | 208627 | 01 | CONNECTICARE | OTHER | 4487076 | 01 | HEALTHSOURCE CMHC | OTHER | J23473 | 01 | BLUE CROSS BLUE SHIELD | OTHER | B10496101 | 01 | CIGNA | OTHER |