Provider Demographics
NPI:1225195241
Name:MCCLAY, MARIE SCHROEDER (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SCHROEDER
Last Name:MCCLAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CHESTNUT ST FL 14
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:215-955-1120
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:833 CHESTNUT ST FRNT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4420
Practice Address - Country:US
Practice Address - Phone:215-955-5000
Practice Address - Fax:215-923-1089
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002055G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023810340001Medicaid
PA1023810340001Medicaid