Provider Demographics
NPI:1255741864
Name:MCLEAN, VIRGINIA ELIZABETH (M D)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:375 E MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8418
Mailing Address - Country:US
Mailing Address - Phone:631-533-9733
Mailing Address - Fax:631-666-9734
Practice Address - Street 1:600 SUFFOLK AVE STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4311
Practice Address - Country:US
Practice Address - Phone:631-273-3712
Practice Address - Fax:631-273-3745
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY295749207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty