Provider Demographics
NPI:1730307521
Name:MCLAM, ELISHA CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:CHRISTINE
Last Name:MCLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-0320
Mailing Address - Country:US
Mailing Address - Phone:802-454-8336
Mailing Address - Fax:
Practice Address - Street 1:157 TOWNE AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:VT
Practice Address - Zip Code:05667-9425
Practice Address - Country:US
Practice Address - Phone:802-454-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0012498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020867Medicaid