Individual
MS. PENELOPE LYN MCCLURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
111 N MAPLEMERE RD STE 100, WILLIAMSVILLE, NY 14221-3182
(716) 204-3200
(716) 204-4337
Mailing address
4225 GENESEE ST, CHEEKTOWAGA, NY 14225-1994
(716) 204-3200
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
005649-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005649
LICENSE
NY
Enumeration date
11/14/2005
Last updated
02/06/2024
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