Healthcare Provider Details

I. General information

NPI: 1164337887
Provider Name (Legal Business Name): PAUL MCCLEARY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S HENDERSON RD STE 150
KING OF PRUSSIA PA
19406-4234
US

IV. Provider business mailing address

232 E PRICE ST
PHILADELPHIA PA
19144-2148
US

V. Phone/Fax

Practice location:
  • Phone: 484-685-4866
  • Fax:
Mailing address:
  • Phone: 484-685-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP036548
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: