Provider Demographics
NPI:1063489201
Name:MCEWAN, MICHELE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:MCEWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 WATERLOO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2639
Mailing Address - Country:US
Mailing Address - Phone:443-451-1614
Mailing Address - Fax:443-451-1619
Practice Address - Street 1:5900 WATERLOO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2639
Practice Address - Country:US
Practice Address - Phone:443-451-1614
Practice Address - Fax:443-451-1619
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG20524Medicare UPIN