Provider Demographics
NPI:1922098680
Name:MCCLOY, STANLEY WINGER JR (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:WINGER
Last Name:MCCLOY
Suffix:JR
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:PO BOX 3635
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4018
Mailing Address - Country:US
Mailing Address - Phone:803-929-7784
Mailing Address - Fax:803-929-7761
Practice Address - Street 1:7142 WOODROW ST
Practice Address - Street 2:SUITE B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2832
Practice Address - Country:US
Practice Address - Phone:803-929-7784
Practice Address - Fax:803-929-7761
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC303727Medicaid
OHG49524Medicare UPIN
SC303727Medicaid