Provider Demographics
NPI:1437594272
Name:ALEXANDRA B. MCLEAN, M.D., PC
Entity type:Organization
Organization Name:ALEXANDRA B. MCLEAN, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-896-9870
Mailing Address - Street 1:121 COULTER AVE
Mailing Address - Street 2:207
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2418
Mailing Address - Country:US
Mailing Address - Phone:610-896-9870
Mailing Address - Fax:610-896-9871
Practice Address - Street 1:121 COULTER AVE
Practice Address - Street 2:207
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2418
Practice Address - Country:US
Practice Address - Phone:610-896-9870
Practice Address - Fax:610-896-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057719L302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization