Provider Demographics
NPI:1497934202
Name:MCCLUNG, BRAXTON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAXTON
Middle Name:
Last Name:MCCLUNG
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 1:4853 GALAXY PKWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5973
Mailing Address - Country:US
Mailing Address - Phone:216-831-9786
Mailing Address - Fax:216-831-2425
Practice Address - Street 1:4853 GALAXY PKWY
Practice Address - Street 2:SUITE I
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5973
Practice Address - Country:US
Practice Address - Phone:216-831-9786
Practice Address - Fax:216-831-2425
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0980822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9079891OtherAETNA
OH204881619259OtherCARESOURCE
OH0064093Medicaid
PA1027686330001Medicaid
OH204881619OtherKAISER
OHP01083159OtherRAILROAD MEDICARE
OH0064093Medicaid