Provider Demographics
NPI:1831967140
Name:MCLEAN, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 BOOMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:WV
Mailing Address - Zip Code:25031
Mailing Address - Country:US
Mailing Address - Phone:304-419-8355
Mailing Address - Fax:
Practice Address - Street 1:4510 PENNSYLVANIA AVE STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4835
Practice Address - Country:US
Practice Address - Phone:304-965-9081
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker