Healthcare Provider Details

I. General information

NPI: 1184796070
Provider Name (Legal Business Name): RODNEY ANTHONY MCLAREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 EATON PL STE 430
FAIRFAX VA
22030-2208
US

IV. Provider business mailing address

10400 EATON PL STE 430
FAIRFAX VA
22030-2208
US

V. Phone/Fax

Practice location:
  • Phone: 703-277-9510
  • Fax: 703-277-9523
Mailing address:
  • Phone: 703-277-9510
  • Fax: 703-277-9523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101043063
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101043063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: