Active NPI
Nathaniel H McClellan, MT
- Specialist
- Portland, ME
National Provider Identifier
1295856490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MT3072
- Practice address
- 19 Temple St
Portland, ME 04101-4011 - Phone
- (207) 773-8393
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MT3072 | ME | Primary |
Addresses
Primary practice location
19 Temple St
Portland, ME 04101-4011
Mailing address
19 Temple St
Portland, ME 04101-4011
Phone (207) 773-8393
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 099082 | Other | ME | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT3072 | ME | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295856490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 TEMPLE ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014011",
"telephone_number": "207-773-8393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 TEMPLE ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041014011",
"telephone_number": "207-773-8393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "NATHANIEL",
"middle_name": "H",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ME",
"license": "MT3072",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "099082",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.