Provider Demographics
NPI:1790770584
Name:MCCLEARY, MARC DENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DENTON
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-786-8010
Mailing Address - Fax:856-786-0529
Practice Address - Street 1:1404-1406 ROUTE 130 NORTH
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-786-8010
Practice Address - Fax:856-786-0529
Is Sole Proprietor?:No
Enumeration Date:2005-09-17
Last Update Date:2022-09-15
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA11295500207Q00000X
MO2005026251207Q00000X
IN01062896A207Q00000X
IL036120687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN