Provider Demographics
NPI:1427077320
Name:MACLELLAN, WILLIAM ROBB (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBB
Last Name:MACLELLAN
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356422
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6422
Mailing Address - Country:US
Mailing Address - Phone:206-616-1040
Mailing Address - Fax:206-616-4847
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356422
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6422
Practice Address - Country:US
Practice Address - Phone:206-616-1040
Practice Address - Fax:206-616-4847
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84856207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G848560Medicaid
CAWG84856AMedicare PIN