Provider Demographics
NPI:1750538187
Name:D M MCCLELLAN MD PA
Entity type:Organization
Organization Name:D M MCCLELLAN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-328-4888
Mailing Address - Street 1:P O BOX 1969
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-7969
Mailing Address - Country:US
Mailing Address - Phone:281-328-4888
Mailing Address - Fax:281-328-8345
Practice Address - Street 1:5214 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-5825
Practice Address - Country:US
Practice Address - Phone:281-328-4888
Practice Address - Fax:281-328-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9345OtherMEDICARE PIN
TX00Z953Medicare PIN
TXB24709Medicare UPIN