Individual
NATHANIEL H MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
19 TEMPLE ST, PORTLAND, ME 04101-4011
(207) 773-8393
Mailing address
19 TEMPLE ST, PORTLAND, ME 04101-4011
(207) 773-8393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT3072
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099082
ANTHEM
ME
Enumeration date
04/03/2007
Last updated
07/08/2007
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