Healthcare Provider Details

I. General information

NPI: 1629043468
Provider Name (Legal Business Name): SUSAN SIMMONS MACLEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CAMPUS DR
BURNSVILLE NC
28714-9010
US

IV. Provider business mailing address

800 MEDICAL CAMPUS DR
BURNSVILLE NC
28714-9010
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-0200
  • Fax:
Mailing address:
  • Phone: 828-682-0200
  • Fax: 828-682-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200000260
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: