Healthcare Provider Details

I. General information

NPI: 1174552707
Provider Name (Legal Business Name): WILLIAM ALFRED MCCLELLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 REYNOLDS ST
MONROE NC
28112-4351
US

IV. Provider business mailing address

1107 REYNOLDS ST
MONROE NC
28112-4351
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-8220
  • Fax: 704-752-7576
Mailing address:
  • Phone: 704-289-8220
  • Fax: 704-752-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number94-00573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: