Provider Demographics
NPI:1497831879
Name:MCCLUNG, REGINALD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:JAY
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:331 LAIDLEY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1619
Mailing Address - Country:US
Mailing Address - Phone:304-344-2345
Mailing Address - Fax:304-344-2347
Practice Address - Street 1:331 LAIDLEY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1619
Practice Address - Country:US
Practice Address - Phone:304-344-2345
Practice Address - Fax:304-344-2347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2014-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV14073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV080018703OtherRAILROAD MEDICARE
WV001874582OtherBLUE CROSS BLUE SHIELD
WV0051700000Medicaid
WV001874582OtherBLUE CROSS BLUE SHIELD
WV0652404Medicare PIN