Provider Demographics
NPI:1639110596
Name:MACLEOD, CAROLINE LUSK (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LUSK
Last Name:MACLEOD
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 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-843-1819
Mailing Address - Fax:818-843-1964
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-843-1819
Practice Address - Fax:818-843-1964
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist