Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD447039 | PA |
NPI | 1043546591 |
---|---|
Provider Name | Dr. Zachary Mcclain |
First Address | Philadelphia, PA 19107-3377 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2009 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030173810001 | (05) | PA |