Provider Demographics
NPI:1144272071
Name:MCCLEAN, CHARLES M (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:MCCLEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 MATLOCK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3679
Mailing Address - Country:US
Mailing Address - Phone:817-557-1900
Mailing Address - Fax:817-557-1942
Practice Address - Street 1:3600 MATLOCK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3679
Practice Address - Country:US
Practice Address - Phone:817-557-1900
Practice Address - Fax:817-557-1942
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0590207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease