Provider Demographics
NPI:1730169541
Name:MCLEAN, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:4125 IRONBOUND RD STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2666
Practice Address - Country:US
Practice Address - Phone:757-345-2829
Practice Address - Fax:757-345-0644
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200500637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE3773OtherMEDCOST
VA1730169541Medicaid
NC5619144OtherCIGNA
NC140P5OtherBCBS
NC5901252Medicaid
NC7670738OtherATENA
NCI40764Medicare UPIN
NC5901252Medicaid