Provider Demographics
NPI:1073735346
Name:MCLAIN, DOMINICK HARRY (DO,)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:HARRY
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 WILLOW WOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2044
Mailing Address - Country:US
Mailing Address - Phone:304-465-5764
Mailing Address - Fax:
Practice Address - Street 1:1600 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-252-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV750207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine