Provider Demographics
NPI:1508831777
Name:MCLEAN, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:929 SPRING CREEK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3964
Mailing Address - Country:US
Mailing Address - Phone:423-892-3400
Mailing Address - Fax:423-892-8266
Practice Address - Street 1:929 SPRING CREEK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3964
Practice Address - Country:US
Practice Address - Phone:423-892-3400
Practice Address - Fax:423-892-8266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN10879208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59351Medicare UPIN