Provider Demographics
NPI:1366605628
Name:MCCLENDON, NICOLE ANNETTE (MD)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNETTE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:431 PARK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3305
Mailing Address - Country:US
Mailing Address - Phone:703-528-6300
Mailing Address - Fax:703-525-1967
Practice Address - Street 1:431 PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3305
Practice Address - Country:US
Practice Address - Phone:703-528-6300
Practice Address - Fax:703-525-1967
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243745207VX0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist