Provider Demographics
NPI:1538191283
Name:MCCLERNAN, MATTHEW H (IDC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:H
Last Name:MCCLERNAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 NE ETON LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9591
Mailing Address - Country:US
Mailing Address - Phone:360-692-2121
Mailing Address - Fax:
Practice Address - Street 1:USS KENTUCKY SSBN 737 GOLD
Practice Address - Street 2:2100 THRESHER AVE
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315
Practice Address - Country:US
Practice Address - Phone:360-315-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman