Provider Demographics
NPI:1679666887
Name:MCCLOY, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCCLOY
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 1:222 AUBURN ST
Mailing Address - Street 2:MIW, STE 102
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6004
Mailing Address - Country:US
Mailing Address - Phone:207-828-4299
Mailing Address - Fax:207-828-5056
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:MIW, STE 102
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-828-4299
Practice Address - Fax:207-828-5056
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME016847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433047599Medicaid
ME433047599Medicaid
I46933Medicare UPIN
MEME171201Medicare PIN