Provider Demographics
NPI:1609961853
Name:MCCLELLAN, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:MCCLELLAN
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:PO BOX 890283
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0283
Mailing Address - Country:US
Mailing Address - Phone:252-672-7745
Mailing Address - Fax:252-635-6951
Practice Address - Street 1:2115 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4309
Practice Address - Country:US
Practice Address - Phone:252-633-4461
Practice Address - Fax:252-633-6016
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000539207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00375320OtherRR MEDICARE
NC14379OtherBCBS PROVIDER NUMBER
NC2061906Medicare PIN
NC14379OtherBCBS PROVIDER NUMBER