Provider Demographics
NPI:1730374885
Name:MCCLELLAN, WILLIAM THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MCCLELLAN
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 1:5000 COOMBS FARM DR.
Mailing Address - Street 2:STE 102
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1122
Mailing Address - Country:US
Mailing Address - Phone:304-777-4677
Mailing Address - Fax:304-777-4679
Practice Address - Street 1:5000 COOMBS FARM DR.
Practice Address - Street 2:STE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1122
Practice Address - Country:US
Practice Address - Phone:304-777-4677
Practice Address - Fax:304-777-4679
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV21436208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery