Provider Demographics
NPI:1043223258
Name:MACPHEDRAN, SALLY E (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:E
Last Name:MACPHEDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2683 PACIFIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-989-5722
Mailing Address - Fax:562-989-5732
Practice Address - Street 1:2500 METROHEALTH MEDICAL CENTER
Practice Address - Street 2:2500 METROHEALTH DRIVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83611207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836110Medicaid