Provider Demographics
NPI:1871991729
Name:MCLAREN MEDICAL CENTER PC
Entity type:Organization
Organization Name:MCLAREN MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULKAREEM
Authorized Official - Middle Name:I
Authorized Official - Last Name:KRAIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-417-6424
Mailing Address - Street 1:5140 PORT TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:NANJEMOY
Mailing Address - State:MD
Mailing Address - Zip Code:20662-3317
Mailing Address - Country:US
Mailing Address - Phone:240-417-6424
Mailing Address - Fax:
Practice Address - Street 1:3606 FOREST DR
Practice Address - Street 2:STE B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1005
Practice Address - Country:US
Practice Address - Phone:240-417-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty