Healthcare Provider Details

I. General information

NPI: 1982947685
Provider Name (Legal Business Name): WILLIAM CARPENTER MACLEAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 UPPER CHELSEA RD
COLUMBUS OH
43212-1938
US

IV. Provider business mailing address

1800 UPPER CHELSEA RD
COLUMBUS OH
43212-1938
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-6170
  • Fax: 614-486-6170
Mailing address:
  • Phone: 614-486-6170
  • Fax: 614-486-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number048229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: