Healthcare Provider Details

I. General information

NPI: 1699783373
Provider Name (Legal Business Name): ROBERT KEENE MCLELLAN MD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-3850
  • Fax:
Mailing address:
  • Phone: 603-650-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number8417
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: