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General NPI Number Information
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NPI Number | 1518548023
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Entity Type | Individual
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Provider Name | RYAN MCCLELLAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-2339
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 MANCHESTER LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4533
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Country | US
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Telephone | 339-237-7394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101276559
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License Number State | VA
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