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Organization
T.W. MACLENNAN, M.D., A MEDICAL CORP
Active
Organization
T.W. MACLENNAN, M.D., A MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MACLENNAN M.D. (MEDICAL DIRECTOR)
(559) 310-0287
Entity
Organization
Contact information
Practice address
465 W PUTNAM AVE, PORTERVILLE, CA 93257-3320
(559) 310-0287
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(559) 310-0287
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK5177
RAILROAD MEDICARE
—
05
—
GR0093330
—
CA
01
—
ZZZ05720Z
BLUE SHIELD
—
Enumeration date
06/21/2006
Last updated
02/04/2019
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