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NPI Code Detail

MEDICARE: MARY T MCLENNAN MD

MEDICARE: MARY T MCLENNAN 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
1207VG0400XGynecology Physician102677MO
2207V00000XObstetrics & Gynecology Physician102677MO
3207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician102677MO

General Provider Information

NPI Number : 1659382216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY T MCLENNAN MD
Provider Business Mailing Address
First Line : 6420 CLAYTON RD
Second Line : SUITE 290
City : SAINT LOUIS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 314-781-1031
Fax Number : 314-781-2840
Provider Business Practice Location Address
First Line : 1031 BELLEVUE AVE STE 200
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1856
Country : US
Telephone Number : 314-977-7455
Fax Number : 314-977-7477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 01/18/2021

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