Basic Information
| Provider Information | |||||||||
| NPI: | 1770618498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLELLAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657981 | ||||||||
| FaxNumber: | 2562654987 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 GOVERNORS DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358012700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657981 | ||||||||
| FaxNumber: | 2562654987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 31847 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0210X | 31847 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | 208M00000X | 31847 | AL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 31847 | 01 | AL | AL LICENSE | OTHER |