Provider Demographics
NPI:1275545253
Name:MCCLINTIC, ANDREA ANNETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ANNETTE
Last Name:MCCLINTIC
Suffix:
Gender:F
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0729
Mailing Address - Country:US
Mailing Address - Phone:276-496-4492
Mailing Address - Fax:276-496-4839
Practice Address - Street 1:2195 EUCLID AVE STE 6
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3655
Practice Address - Country:US
Practice Address - Phone:276-669-5179
Practice Address - Fax:276-466-8870
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2172207Q00000X, 208000000X
VA0102205461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine