Provider Demographics
NPI:1174552707
Name:MCCLELLAND, WILLIAM ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALFRED
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4351
Mailing Address - Country:US
Mailing Address - Phone:704-289-8220
Mailing Address - Fax:704-752-7576
Practice Address - Street 1:1107 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4351
Practice Address - Country:US
Practice Address - Phone:704-289-8220
Practice Address - Fax:704-752-7576
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00573207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955797Medicaid
NC94-00573OtherSTATE LICENSE
F82745Medicare UPIN
2199579AMedicare ID - Type Unspecified