Provider Demographics
NPI:1578980835
Name:MCCLANAHAN, CAROLE MARIE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:MARIE
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3129
Mailing Address - Country:US
Mailing Address - Phone:319-356-8913
Mailing Address - Fax:
Practice Address - Street 1:170 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3129
Practice Address - Country:US
Practice Address - Phone:719-471-1763
Practice Address - Fax:719-471-2498
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10181207N00000X
390200000X
CO0059969207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program