Provider Demographics
NPI:1407063241
Name:MCCLURE, MATTHEW G (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:MCCLURE
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 1:825 WEHRLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1718
Mailing Address - Country:US
Mailing Address - Phone:716-634-3502
Mailing Address - Fax:716-634-1930
Practice Address - Street 1:825 WEHRLE DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1718
Practice Address - Country:US
Practice Address - Phone:716-634-3502
Practice Address - Fax:716-634-1930
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188619207R00000X
NY264513207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine