Provider Demographics
NPI:1124002399
Name:MCLEAN, WALTER COPLEY JR (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:COPLEY
Last Name:MCLEAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-258-1586
Mailing Address - Fax:828-258-6161
Practice Address - Street 1:21 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-255-8978
Practice Address - Fax:828-251-9150
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25729207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00200709OtherPALMETTO GBA
NC57503OtherBCBS OF NC
NC8957503Medicaid
NCC85453Medicare UPIN
NC8957503Medicaid
NCP00200709OtherPALMETTO GBA