Provider Demographics
NPI:1588634679
Name:MCLEAN, BARRY KINCAID (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:KINCAID
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OLD MONTGOMERY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-8401
Mailing Address - Country:US
Mailing Address - Phone:205-949-1900
Mailing Address - Fax:205-949-1919
Practice Address - Street 1:10 OLD MONTGOMERY HWY STE 100
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-8401
Practice Address - Country:US
Practice Address - Phone:205-949-1900
Practice Address - Fax:205-949-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51027789OtherBLUE CROSS BLUE SHIELD
ALMC000027789Medicaid
P00059961Medicare PIN
ALD08177Medicare UPIN
ALMC000027789Medicaid