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NPI Code Detail

MEDICARE: MR. JAMES M MCLELLAN MPAS, PA-C

MEDICARE: MR. JAMES M MCLELLAN MPAS, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-04362NC

General Provider Information

NPI Number : 1053658880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES M MCLELLAN MPAS, PA-C
Provider Business Mailing Address
First Line : 1414 MEDICAL CENTER DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7505
Country : US
Telephone Number : 910-763-7363
Fax Number : 910-251-8296
Provider Business Practice Location Address
First Line : 1414 MEDICAL CENTER DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7505
Country : US
Telephone Number : 910-763-7363
Fax Number : 910-251-8296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2013
Last Update Date : 11/15/2017

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