Provider Demographics
NPI:1760821227
Name:MCGILL, CLAIRE ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:ELLEN
Last Name:MCGILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATTN: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:941-782-2800
Mailing Address - Fax:
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5185
Practice Address - Country:US
Practice Address - Phone:941-782-2800
Practice Address - Fax:941-782-2513
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 3669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine