Provider Demographics
NPI:1700078771
Name:MCLEAN, KELLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:C
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:C
Other - Last Name:WULFKUHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:4TH FLOOR, WOMEN'S SERVICES, C/O AMY BOURGIOUS
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-1400
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:4TH FLOOR, WOMEN'S SERVICES, C/O AMY BOURGIOUS
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT390200000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology