MEDICARE: MATTHEW DOUGLAS MCLAREN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	29650	SC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	200400236	NC
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	11260	MT
4	208VP0014X	Interventional Pain Medicine Physician	200400236	NC
5	208VP0014X	Interventional Pain Medicine Physician	29650	SC
6	207LP2900X	Pain Medicine (Anesthesiology) Physician	29650	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	011004307	OTHER	MT	PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598760332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DOUGLAS MCLAREN MD

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY STE 205
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7096
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Provider Business Practice Location Address
First Line	:	180 WINGO WAY STE 105
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1810
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/07/2025

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Directions to “ MATTHEW DOUGLAS MCLAREN MD” Practice Location

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