Provider Demographics
NPI:1265419410
Name:MCCLENNEN, SETH (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:MCCLENNEN
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 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1200
Mailing Address - Fax:781-340-1610
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1200
Practice Address - Fax:781-340-1610
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160065207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469016OtherTUFTS HEALTH PLAN
MAAA11795OtherHARVARD PILGRIM
MA91036OtherFALLON COMM HEALTH PLAN
MA0033355OtherNEIGHBORHOOD HEALTH PLAN
MAJ27401OtherBLUE CROSS BLUE SHIELD
MA2062861Medicaid
MAI00975Medicare UPIN
MAA36416Medicare PIN
MA2062861Medicaid