Provider Demographics
NPI:1386650463
Name:MCLEAN, ALEXANDRA B (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:B
Last Name:MCLEAN
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 1:150 STAFFORD AVENUE - BLDG. 1 - 2ND FLOOR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3114
Mailing Address - Country:US
Mailing Address - Phone:610-896-9870
Mailing Address - Fax:610-896-9871
Practice Address - Street 1:150 STAFFORD AVENUE - BLDG. 1 - 2ND FLOOR
Practice Address - Street 2:SUITE 210
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3114
Practice Address - Country:US
Practice Address - Phone:610-896-9870
Practice Address - Fax:610-896-9871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057719L2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001671627Medicaid
PAG36351Medicare UPIN
PA001671627Medicaid