Provider Demographics
NPI:1730185364
Name:MCCLAIN, TIMOTHY P (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 PRINCE GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4361
Mailing Address - Country:US
Mailing Address - Phone:301-725-0600
Mailing Address - Fax:301-725-4040
Practice Address - Street 1:8871 GORMAN RD STE 300
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5877
Practice Address - Country:US
Practice Address - Phone:301-498-3150
Practice Address - Fax:410-601-8886
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152931500Medicaid
MD52317601OtherBLUE SHIELD OF MD
DC80160012OtherBLUE SHIELD NATIONAL AREA
MD680849W00Medicare ID - Type Unspecified