Provider Demographics
NPI:1932660487
Name:MCCLUNG, LAURA MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MELISSA
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 PARNASSUS AVE., S436, BOX 0427
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-353-1297
Mailing Address - Fax:415-353-1990
Practice Address - Street 1:513 PARNASSUS AVE., S436, BOX 0427
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-353-1297
Practice Address - Fax:415-353-1990
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA188165207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program