Provider Demographics
NPI:1912072455
Name:MCLEAN, CHRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COACH DR
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1354
Mailing Address - Country:US
Mailing Address - Phone:860-434-6474
Mailing Address - Fax:
Practice Address - Street 1:8 VISTA DR
Practice Address - Street 2:EASTPORT NORTH BUSINESS PARK
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1587
Practice Address - Country:US
Practice Address - Phone:860-434-8849
Practice Address - Fax:860-434-0428
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033793207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D78166Medicare UPIN