MEDICARE: LAURIE ANNE CLELAND 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
1	2085R0202X	Diagnostic Radiology Physician	MD00036175	WA
2	2085R0202X	Diagnostic Radiology Physician	MD15620	OR
3	2085R0202X	Diagnostic Radiology Physician	G87623	CA

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	:	1881698819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE ANNE CLELAND MD

Provider Business Mailing Address
First Line	:	1624 W OLIVE AVE
Second Line	:	SUITE F
City	:	BURBANK
State	:	CA
Zip	:	91506-2459
Country	:	US
Telephone Number	:	818-843-2835
Fax Number	:	818-843-3310

Provider Business Practice Location Address
First Line	:	1624 W OLIVE AVE
Second Line	:	SUITE F
City	:	BURBANK
State	:	CA
Zip	:	91506-2459
Country	:	US
Telephone Number	:	818-843-2835
Fax Number	:	818-843-3310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/10/2024

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