Provider Demographics
NPI:1285955666
Name:MCLAREN, CHRISTOPHER THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5067 55TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3809
Mailing Address - Country:US
Mailing Address - Phone:507-292-7070
Mailing Address - Fax:
Practice Address - Street 1:5067 55TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3809
Practice Address - Country:US
Practice Address - Phone:507-292-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA 001213363AM0700X, 363AS0400X
NC0010-02263363AM0700X
MN11848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-02263OtherNC MEDICAL LICENSE
MEPA 001213OtherMAINE MEDICAL LICENSE NUMBER
MN11848OtherMINNESOTA MEDICAL LICENSE