Provider Demographics
NPI:1518220631
Name:LECLERC, MCKALYN GARRITY (MD)
Entity Type:Individual
Prefix:DR
First Name:MCKALYN
Middle Name:GARRITY
Last Name:LECLERC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:165 SHERMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:4 SLAPP HILL ROAD
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-3300
Practice Address - Fax:802-472-8277
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHRT2395207Q00000X
VT42.0013105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine