Provider Demographics
NPI:1114926193
Name:MCGRANE, MAURA F (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:F
Last Name:MCGRANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2757
Mailing Address - Country:US
Mailing Address - Phone:978-922-9778
Mailing Address - Fax:978-922-3878
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:SUITE 2001
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2757
Practice Address - Country:US
Practice Address - Phone:978-922-9778
Practice Address - Fax:978-922-3878
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3142990Medicaid
MAG11482Medicare UPIN
MAA20312Medicare ID - Type Unspecified