Provider Demographics
NPI:1598760332
Name:MCLAREN, MATTHEW DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:855-527-7246
Mailing Address - Fax:866-229-5063
Practice Address - Street 1:180 WINGO WAY STE 105
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:866-229-5063
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29650207L00000X, 208VP0014X, 207LP2900X
NC200400236207LP2900X, 208VP0014X
MT11260207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC296502Medicaid
MT011004307OtherPTAN
NC89136YNMedicaid
NC1598760332Medicaid