Provider Demographics
NPI:1861501751
Name:ALBERT A. MCCLAIN, JR., M.D., INC.
Entity Type:Organization
Organization Name:ALBERT A. MCCLAIN, JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:619-267-8440
Mailing Address - Street 1:655 EUCLID AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2978
Mailing Address - Country:US
Mailing Address - Phone:619-267-8440
Mailing Address - Fax:619-267-8032
Practice Address - Street 1:655 EUCLID AVE STE 401
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2978
Practice Address - Country:US
Practice Address - Phone:619-267-8440
Practice Address - Fax:619-267-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71625207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G716250Medicaid
F38110Medicare UPIN
W18701Medicare PIN