Provider Demographics
NPI:1043863681
Name:MACLEAN, RACHEL LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7247 POMMEL DR
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5986
Mailing Address - Country:US
Mailing Address - Phone:443-974-2665
Mailing Address - Fax:
Practice Address - Street 1:231 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3915
Practice Address - Country:US
Practice Address - Phone:860-875-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MDC0008145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant