MEDICARE: DR. ROGER MCCLELLAN M.D.

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
1	2085R0202X	Diagnostic Radiology Physician	A25690	CA

General Provider Information

NPI Number	:	1649289182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER MCCLELLAN M.D.

Provider Business Mailing Address
First Line	:	6311 TURNBERRY CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5584
Country	:	US
Telephone Number	:	714-960-7977
Fax Number	:

Provider Business Practice Location Address
First Line	:	6311 TURNBERRY CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5584
Country	:	US
Telephone Number	:	714-960-7977
Fax Number	:	714-960-8534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/13/2012

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