Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD012995E | PA |
Y | 208600000X | Surgeon | MD012995E | PA |
N | 2082S0105X | Plastic Hand Surgeon | MD012995E | PA |
NPI | 1225043961 |
---|---|
Provider Name | Dr. Robert Michael Mcclellan |
First Address | Media, PA 19063-6104 |
Second Address | Media, PA 19063-6104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D68709 | (02) | PA |