Provider Demographics
NPI:1811006786
Name:MCCLAIN, ALBERT A JR (M D)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:MCCLAIN
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 REISLING TERRACE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913
Mailing Address - Country:US
Mailing Address - Phone:619-267-8440
Mailing Address - Fax:877-795-8215
Practice Address - Street 1:830 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4034
Practice Address - Country:US
Practice Address - Phone:315-786-4824
Practice Address - Fax:315-786-4915
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71625207Y00000X
NY288937207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G716250Medicaid
F38110Medicare UPIN
CA00G716250Medicaid