Provider Demographics
NPI:1225043961
Name:MCCLELLAN, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:MCCLELLAN
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 1:1118 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 100, HEALTH CENTER 4
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6104
Mailing Address - Country:US
Mailing Address - Phone:484-227-8350
Mailing Address - Fax:484-227-1645
Practice Address - Street 1:1118 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 100, HEALTH CENTER 4
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6104
Practice Address - Country:US
Practice Address - Phone:484-227-8350
Practice Address - Fax:484-227-1645
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012995E2082S0105X, 208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD68709Medicare UPIN
PAD68709Medicare UPIN
PA050041HDHMedicare PIN