Provider Demographics
NPI:1306020029
Name:MCCLAIN, VINCENT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3946
Mailing Address - Country:US
Mailing Address - Phone:860-559-8565
Mailing Address - Fax:
Practice Address - Street 1:1250 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3946
Practice Address - Country:US
Practice Address - Phone:860-559-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026745207VG0400X, 208D00000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice