Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 9800967 | NC |
NPI | 1124002209 |
---|---|
Provider Name | Thomas Williams Mclean |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1088J | BCBS (01) | NC |
24401 | PARTNERS (01) | |
3000194000 | (05) | WV |
5122690 | AETNA (01) | |
6733557 | (05) | VA |
791088J | (05) | NC |
80505 | MEDCOST (01) | NC |
G46465 | (02) | |
Q0096F | (05) | SC |