Provider Demographics
NPI:1417381641
Name:MACLEOD, WENDY ELLEN JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ELLEN JORDAN
Last Name:MACLEOD
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 1:2709 CANTER DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7814
Mailing Address - Country:US
Mailing Address - Phone:919-732-5770
Mailing Address - Fax:
Practice Address - Street 1:9701 DATA PARK
Practice Address - Street 2:UNITED HEALTH CARE
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9026
Practice Address - Country:US
Practice Address - Phone:919-732-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600622208000000X
ALMD.4399208000000X
FLME 64322208000000X
PAMD072529L208000000X
TN35995208000000X
KY38202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics