Provider Demographics
NPI:1538145313
Name:MCCLEARY, ROBERT W (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3452
Mailing Address - Country:US
Mailing Address - Phone:304-831-1818
Mailing Address - Fax:304-831-1815
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-831-1818
Practice Address - Fax:304-831-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000186000OtherWELFARE
OH2265374Medicaid
H50809Medicare UPIN
WV1000186000OtherWELFARE