Healthcare Provider Details

I. General information

NPI: 1891874087
Provider Name (Legal Business Name): VIRGINIA L MCCLAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 COLUMBIA AVE
LEXINGTON SC
29072-2611
US

IV. Provider business mailing address

247 COLUMBIA AVE
LEXINGTON SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-5533
  • Fax: 803-359-0127
Mailing address:
  • Phone: 803-359-5533
  • Fax: 803-359-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19028
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19028
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: