Provider Demographics
NPI:1932526134
Name:MACLEAN, ELIZABETH WOLF (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WOLF
Last Name:MACLEAN
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 1:301 KILDAIRE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4064
Mailing Address - Country:US
Mailing Address - Phone:919-360-0719
Mailing Address - Fax:
Practice Address - Street 1:301 KILDAIRE RD STE 200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4064
Practice Address - Country:US
Practice Address - Phone:919-360-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125064631208000000X
IL390200000X
NC202301016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program