Provider Demographics
NPI:1235390709
Name:MCCLAIN, ALICE MCCORMICK (LAC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MCCORMICK
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6934
Mailing Address - Country:US
Mailing Address - Phone:301-662-8000
Mailing Address - Fax:301-663-5000
Practice Address - Street 1:245 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6934
Practice Address - Country:US
Practice Address - Phone:301-662-8000
Practice Address - Fax:301-663-5000
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist