Provider Demographics
NPI:1104072628
Name:MACLAREN, DOUGLAS J (LIC AC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:MACLAREN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COREY ST
Mailing Address - Street 2:APT 2R
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1917
Mailing Address - Country:US
Mailing Address - Phone:617-272-6608
Mailing Address - Fax:
Practice Address - Street 1:1895 CENTRE ST
Practice Address - Street 2:STE 205
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1933
Practice Address - Country:US
Practice Address - Phone:617-272-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235522171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist