MEDICARE: MCLEAN SHEPERD, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	18640	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104975663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEAN SHEPERD, MD, LLC

Provider Business Mailing Address
First Line	:	852 LOWCOUNTRY BLVD
Second Line	:	SUITE 102
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3530
Fax Number	:	843-654-9122

Provider Business Practice Location Address
First Line	:	852 LOWCOUNTRY BLVD
Second Line	:	SUITE 102
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3530
Fax Number	:	843-654-9122

Authorized Official
Title or Position	:	OWNER
Name	:	MCLEAN SHEPERD
Credential	:	M.D.
Telephone Number	:	843-216-3530

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	10/04/2011

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