Basic Information
| Provider Information | |||||||||
| NPI: | 1356340814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2989 DIXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032483013 | ||||||||
| FaxNumber: | 2032482878 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037720011 | ||||||||
| FaxNumber: | 2037859352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 12/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 030964 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 730964 | 01 | CT | CONNECTICARE | OTHER | 010030964CT02 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER | 0Q2053 | 01 | CT | HEALTH NET | OTHER | 110165424 | 01 | CT | RAILROAD MEDICARE | OTHER | 2047702 | 01 | CT | AETNA | OTHER | NHP072 | 01 | CT | OXFORD | OTHER |