Provider Demographics
NPI:1750382776
Name:MCCLEAN-RICE, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MCCLEAN-RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19056 GREENBUSH ROAD
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421
Mailing Address - Country:US
Mailing Address - Phone:757-442-3636
Mailing Address - Fax:757-442-2319
Practice Address - Street 1:19056 GREENBUSH ROAD
Practice Address - Street 2:19056 GREENBUSH ROAD
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-4632
Practice Address - Country:US
Practice Address - Phone:757-442-3636
Practice Address - Fax:757-442-2319
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010391682084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA086289OtherSENTARA/OPTIMA
VAC05541OtherMEDICARE GROUP
VA239419OtherANTHEM
VA086289OtherSENTARA
VA013415E41Medicare PIN
VA086289OtherSENTARA/OPTIMA