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NPI Code Detail

MEDICARE: DR. CHARLES D MACLEAN MD

MEDICARE: DR. CHARLES D MACLEAN MD
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
1207R00000XInternal Medicine Physician420007816VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142-0007816OTHERVTSTATE OF VT LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619995792
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES D MACLEAN MD
Provider Business Mailing Address
First Line : 280 COUNTRY LN
Second Line :
City : SHELBURNE
State : VT
Zip : 05482-6932
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 87 MAIN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3234
Country : US
Telephone Number : 802-847-8354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 03/07/2023

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