Provider Demographics
NPI:1386695518
Name:MCLELLAN, FIONA
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 PLUM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693-1116
Practice Address - Country:US
Practice Address - Phone:814-832-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070826L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018137220002Medicaid
PA114129OtherUNISON HEALTH PLAN
PA1546801OtherGATEWAY HEALTH PLAN OB
PA856478OtherHIGHMARK BC/BS
080160961OtherRAILROAD MEDICARE
PA114131OtherUNISON HEALTH PLAN OB
PA214242OtherUPMC HEALTH PLAN
PAP001933OtherGATEWAY HEALTH PLAN
PA1546801OtherGATEWAY HEALTH PLAN OB
PA114129OtherUNISON HEALTH PLAN