Healthcare Provider Details

I. General information

NPI: 1285832618
Provider Name (Legal Business Name): DONALD WAYNE MCLAREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16492 MLC LN
ROCKVILLE VA
23146
US

IV. Provider business mailing address

16492 MLC LN
ROCKVILLE VA
23146
US

V. Phone/Fax

Practice location:
  • Phone: 804-620-3358
  • Fax: 804-620-3178
Mailing address:
  • Phone: 804-620-3358
  • Fax: 804-620-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101234739
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234739
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101234739
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: