Provider Demographics
NPI:1457411134
Name:JOHN R MCLEAN MD & ASSOCIATES PA
Entity Type:Organization
Organization Name:JOHN R MCLEAN MD & ASSOCIATES PA
Other - Org Name:DRS MCLEAN FREY AGARAWAL & ASSOC PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-677-4949
Mailing Address - Street 1:1315 S DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6920
Mailing Address - Country:US
Mailing Address - Phone:410-677-4949
Mailing Address - Fax:401-749-4988
Practice Address - Street 1:1315 S DIVISION STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6920
Practice Address - Country:US
Practice Address - Phone:410-677-4949
Practice Address - Fax:401-749-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000203901OtherMADE INDIVIDUAL
253AJOOtherBSMD GROUP
J333OtherBSDC GROUP
0001OtherBSDC INDIVIDUAL
42418203OtherBSMD INDIVIDUAL
4405389OtherAET
770M335FOtherMBMD INDIVIDUAL
8432071OtherCIG
1000033474OtherDHMO INDIVIDUAL
2500303OtherUHCM
770MOtherMBMD GROUP
DA8686OtherMBRR GROUP
57465OtherCOV
1000025859OtherMADE GROUP
P00075521OtherMBRR INDIVIDUAL
30128OtherMAMS