Healthcare Provider Details

I. General information

NPI: 1316528631
Provider Name (Legal Business Name): EVAN MCCLANAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/23/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 TEAYS VALLEY ROAD
HURRICANE WV
25526-8728
US

IV. Provider business mailing address

1448 10TH AVENUE SUITE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6736
  • Fax: 304-757-0582
Mailing address:
  • Phone: 304-691-6381
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33821
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: