Provider Demographics
NPI:1083661961
Name:MCLAIN, PAMELA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 CAHABA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2602
Mailing Address - Country:US
Mailing Address - Phone:205-991-8996
Mailing Address - Fax:205-991-8997
Practice Address - Street 1:2229 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2602
Practice Address - Country:US
Practice Address - Phone:205-991-8996
Practice Address - Fax:205-991-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C78720Medicare UPIN