Provider Demographics
NPI:1184162810
Name:MCLEAN, DARIUS (PA-C)
Entity type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MISSENBURG CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2364
Mailing Address - Country:US
Mailing Address - Phone:910-373-1828
Mailing Address - Fax:
Practice Address - Street 1:300 E WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1229
Practice Address - Country:US
Practice Address - Phone:336-890-3822
Practice Address - Fax:336-663-5367
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10248225X00000X
363AM0700X
NC0010-11169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical