Healthcare Provider Details

I. General information

NPI: 1235125808
Provider Name (Legal Business Name): STEVEN GEORGE MCCLOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SMITHFIELD AVE AXIOM OCCUPATIONAL HEALTH LLC
PAWTUCKET RI
02860-3474
US

IV. Provider business mailing address

100 SMITHFIELD AVE AXIOM OCCUPATIONAL HEALTH LLC
PAWTUCKET RI
02860-3497
US

V. Phone/Fax

Practice location:
  • Phone: 401-312-0545
  • Fax: 401-725-8064
Mailing address:
  • Phone: 401-312-0545
  • Fax: 401-312-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number05160
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number05160
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: