Provider Demographics
NPI:1669449070
Name:MCCLELLAND, ROBERT CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRAIG
Last Name:MCCLELLAND
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 1:1721 EBENEZER RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-328-2401
Mailing Address - Fax:803-328-1030
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 145
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-328-2401
Practice Address - Fax:803-328-1030
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214887Medicaid
SCH125961467Medicare PIN
SC214887Medicaid