Provider Demographics
NPI:1255867750
Name:MCCLELLAN, SAMUEL ALEXANDER
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALEXANDER
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3540
Mailing Address - Country:US
Mailing Address - Phone:413-587-4600
Mailing Address - Fax:
Practice Address - Street 1:8 RIVER DR
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3540
Practice Address - Country:US
Practice Address - Phone:413-587-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No173C00000XOther Service ProvidersReflexologist