Provider Demographics
NPI:1881617827
Name:WALTHER, MCCLELLAN (MD)
Entity type:Individual
Prefix:
First Name:MCCLELLAN
Middle Name:
Last Name:WALTHER
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 1:320 HIGHLAND RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-7811
Mailing Address - Country:US
Mailing Address - Phone:301-987-0278
Mailing Address - Fax:
Practice Address - Street 1:5804 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1623
Practice Address - Country:US
Practice Address - Phone:301-927-7800
Practice Address - Fax:301-209-9474
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037713208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology