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General NPI Number Information
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NPI Number | 1659484640
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Entity Type | Individual
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Provider Name | BRUCE JON MCCLELLAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE PATRICK 1 - RADIOLOGY
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-8873
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COLCHESTER AVE PATRICK 1 - RADIOLOGY
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-8873
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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 | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number | 051-0001315
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 055-0030731
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License Number State | VT
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