Provider Demographics
NPI:1245216969
Name:MCCLARREN, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MCCLARREN
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:PO BOX 418
Mailing Address - Street 2:495 S SHOOP AVE
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-0418
Mailing Address - Country:US
Mailing Address - Phone:419-335-7921
Mailing Address - Fax:419-337-5988
Practice Address - Street 1:495 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-0418
Practice Address - Country:US
Practice Address - Phone:419-335-7921
Practice Address - Fax:419-337-5988
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048828M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0532614Medicaid
OH0532614Medicaid
OH0539503Medicare PIN