Provider Demographics
NPI:1861484230
Name:MCCLELLAND, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30365
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0365
Mailing Address - Country:US
Mailing Address - Phone:252-628-8300
Mailing Address - Fax:252-642-6622
Practice Address - Street 1:114 FOREST HILL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3728
Practice Address - Country:US
Practice Address - Phone:252-628-8300
Practice Address - Fax:252-642-6622
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134GAMedicaid
NC134GAOtherBCBS NC
2019123Medicare PIN
P00036714Medicare PIN
NC89134GAMedicaid