Provider Demographics
NPI:1043389638
Name:MCKENNA, MARGARET WEYLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:WEYLAND
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3528
Mailing Address - Country:US
Mailing Address - Phone:781-721-2226
Mailing Address - Fax:617-638-7075
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:DOWLING 5108
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-638-7062
Practice Address - Fax:617-638-7075
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA50247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA02095033Medicaid
MAJ02500Medicare ID - Type Unspecified
MA02095033Medicaid