Provider Demographics
NPI:1215183736
Name:MCLAIN, AMANDA V (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:V
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:ROOM 339
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5359
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:29 CRAFT ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458
Practice Address - Country:US
Practice Address - Phone:617-964-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine