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NPI Code Detail

MEDICARE: MCCLELLAN WALTHER M.D.

MEDICARE:   MCCLELLAN  WALTHER  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
1208800000XUrology PhysicianD0037713MD

General Provider Information

NPI Number : 1881617827
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCCLELLAN WALTHER M.D.
Provider Business Mailing Address
First Line : 320 HIGHLAND RIDGE AVE
Second Line :
City : GAITHERSBURG
State : MD
Zip : 20878-7811
Country : US
Telephone Number : 301-987-0278
Fax Number :
Provider Business Practice Location Address
First Line : 5804 BALTIMORE AVE
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20781-1623
Country : US
Telephone Number : 301-927-7800
Fax Number : 301-209-9474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/08/2007

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Directions to “ MCCLELLAN WALTHER M.D.” Practice Location

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