Provider Demographics
NPI:1053332858
Name:MCCLELLAN, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2544 COURT DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3450
Mailing Address - Country:US
Mailing Address - Phone:704-864-7821
Mailing Address - Fax:704-865-0519
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:SUITE G
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-864-7821
Practice Address - Fax:704-865-0519
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC39851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955767Medicaid
SCN39851OtherSC MEDICAID
E58255Medicare UPIN
NC2154314Medicare PIN