Provider Demographics
NPI:1871669002
Name:MCCLAIN, PAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 FAIR LAKES PARKWAY
Mailing Address - Street 2:KAISER PERMANENTE FAIR OAKS MEDICAL CENTER
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3952
Mailing Address - Country:US
Mailing Address - Phone:703-934-5700
Mailing Address - Fax:
Practice Address - Street 1:12255 FAIR LAKES PARKWAY
Practice Address - Street 2:KAISER PERMANENTE FAIR OAKS MEDICAL CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3952
Practice Address - Country:US
Practice Address - Phone:703-934-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41047207R00000X
AZ15591207R00000X
GA048370207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E47678Medicare UPIN
009556M92Medicare ID - Type Unspecified