Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 206178-1 | NY |
N | 207Q00000X | Family Doctor | 94-01201 | NC |
N | 207Q00000X | Family Doctor | T3025 | SC |
N | 207QA0401X | Family Doctor - Addiction Medicine | 206178 | NY |
NPI | 1619176955 |
---|---|
Provider Name | Melanie Maclennan |
First Address | New York, NY 10009-5956 |
Second Address | New York, NY 10009-5956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 13/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2148685 | (05) | NY |
G25497 | (02) | NC |