Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 0101041309 | VA |
NPI | 1093840811 |
---|---|
Provider Name | Dr. Mark Allen Mcclanahan |
First Address | Fredericksburg, VA 22408-2674 |
Second Address | Fredericksburg, VA 22408-2674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6079041 | (05) | VA |
D93704 | (02) | VA |