Provider Demographics
NPI:1831306273
Name:MCCLELLAND, EDWIN BASHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:BASHAW
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3733 SAN JOSE AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2264
Mailing Address - Country:US
Mailing Address - Phone:858-531-0740
Mailing Address - Fax:
Practice Address - Street 1:2055 3RD AVE
Practice Address - Street 2:SUITE NUMBER 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2037
Practice Address - Country:US
Practice Address - Phone:619-233-8018
Practice Address - Fax:619-233-8020
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA84135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine