Provider Demographics
NPI:1508504291
Name:IRELAND, MARIANNE MCLELLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:MCLELLAN
Last Name:IRELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0898
Mailing Address - Country:US
Mailing Address - Phone:772-285-4890
Mailing Address - Fax:772-692-5654
Practice Address - Street 1:509 SW CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2921
Practice Address - Country:US
Practice Address - Phone:772-285-4890
Practice Address - Fax:772-692-5654
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME629242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty