Healthcare Provider Details

I. General information

NPI: 1730110107
Provider Name (Legal Business Name): JAMES M MCCLANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 STEVENS ST
NORWALK CT
06850-3859
US

IV. Provider business mailing address

30 STEVENS ST
NORWALK CT
06850-3859
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2262
  • Fax: 203-899-5281
Mailing address:
  • Phone: 203-852-2262
  • Fax: 203-899-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number39466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: