Healthcare Provider Details

I. General information

NPI: 1518498765
Provider Name (Legal Business Name): CAMERON MCLEAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 NORTH ST
BATAVIA NY
14020-1631
US

IV. Provider business mailing address

3 TOUNTAS AVE STE 4
LE ROY NY
14482-1368
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-5412
  • Fax:
Mailing address:
  • Phone: 585-768-6530
  • Fax: 585-768-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number296113
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number296113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: