Provider Demographics
NPI:1932100138
Name:MCLELLAND, KARIN R (MD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:R
Last Name:MCLELLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:E
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15 FACILITY DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-9438
Mailing Address - Country:US
Mailing Address - Phone:828-452-2211
Mailing Address - Fax:828-452-4421
Practice Address - Street 1:15 FACILITY DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9438
Practice Address - Country:US
Practice Address - Phone:828-452-2211
Practice Address - Fax:828-452-4421
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913408Medicaid
NC13408OtherBCBSNC
NC8913408Medicaid