1316140692 NPI number — MCLEAN PEDIATRIC ASSOCIATES, INC.

Table of content: (NPI 1316140692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316140692 NPI number — MCLEAN PEDIATRIC ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEAN PEDIATRIC ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316140692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6711 WHITTIER AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MCLEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22101-4538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-356-5722
Provider Business Mailing Address Fax Number:
703-734-3823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6711 WHITTIER AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MCLEAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22101-4538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-356-5722
Provider Business Practice Location Address Fax Number:
703-734-3823
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
LYNETTE
Authorized Official Middle Name:
KELLY
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
703-356-5722

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101222693 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com