Provider Demographics
NPI:1659382216
Name:MCLENNAN, MARY T (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 CLAYTON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-781-1031
Mailing Address - Fax:314-781-2840
Practice Address - Street 1:1031 BELLEVUE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1856
Practice Address - Country:US
Practice Address - Phone:314-977-7455
Practice Address - Fax:314-977-7477
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102677207VG0400X, 207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology