Provider Demographics
NPI:1669449138
Name:MCCLELLAN, WILLIAM R (RPA C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 NEW SCOTLAND AVE
Mailing Address - Street 2:MC157 THE VASCULAR GROUP PLLC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-5110
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:MC157 THE VASCULAR GROUP PLLC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-5640
Practice Address - Fax:518-262-5110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02340729Medicaid
R86496Medicare UPIN
NY02340729Medicaid