Provider Demographics
NPI:1730182551
Name:MCLEAN, ELLEN B (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:B
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2935
Mailing Address - Country:US
Mailing Address - Phone:504-885-4141
Mailing Address - Fax:504-456-8417
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:STE 240
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2935
Practice Address - Country:US
Practice Address - Phone:504-885-4141
Practice Address - Fax:504-456-8417
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL#013382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12-00204OtherUNITED HEALTHCARE
LA1199702Medicaid
LA4013380OtherAETNA
LA721072326MC1OtherOCHSNER/HUMANA
LAG24407Medicare UPIN
LA4013380OtherAETNA