Provider Demographics
NPI:1477655645
Name:MAC LEAN, KATHERINE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LOUISE
Last Name:MAC LEAN
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 1:780 RESERVOIR AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4425
Mailing Address - Country:US
Mailing Address - Phone:401-709-4652
Mailing Address - Fax:
Practice Address - Street 1:780 RESERVOIR AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4425
Practice Address - Country:US
Practice Address - Phone:401-709-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine