Provider Demographics
NPI:1336180744
Name:MCCLUNG, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WEST AVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1229
Mailing Address - Country:US
Mailing Address - Phone:585-395-6095
Mailing Address - Fax:
Practice Address - Street 1:156 WEST AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1229
Practice Address - Country:US
Practice Address - Phone:585-395-6095
Practice Address - Fax:585-395-6017
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230745207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY230745-2 EMOtherWORKER'S COMPENSATION
NY02568514Medicaid
NY02568514Medicaid
NY230745-2 EMOtherWORKER'S COMPENSATION
RA2441 - GRP:70000AMedicare PIN