Provider Demographics
NPI:1477673622
Name:MCCLELLAN, CARLTON WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:WAYNE
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 215
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-9988
Mailing Address - Fax:301-668-9977
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:STE 215
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:301-668-9988
Practice Address - Fax:301-668-9977
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC002852363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD163692ZELVMedicare PIN