Provider Demographics
NPI:1629043468
Name:MACLEAN, SUSAN SIMMONS (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SIMMONS
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-9010
Mailing Address - Country:US
Mailing Address - Phone:828-682-0200
Mailing Address - Fax:828-682-5095
Practice Address - Street 1:800 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-9010
Practice Address - Country:US
Practice Address - Phone:828-682-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891247GMedicaid
SM4961008OtherUNITED HEALTHCARE
NC1247GOtherBCBS