Provider Demographics
NPI:1134380223
Name:MCLELLAN, KATRINA MARIE KANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:MARIE KANDRA
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:KANDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 74008272
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8272
Mailing Address - Country:US
Mailing Address - Phone:702-899-0595
Mailing Address - Fax:702-977-1496
Practice Address - Street 1:305 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2903
Practice Address - Country:US
Practice Address - Phone:872-231-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0069137208100000X
VA0101245599208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation