Provider Demographics
NPI:1124019765
Name:MCGAUGH, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCGAUGH
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 1:191 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7751
Mailing Address - Country:US
Mailing Address - Phone:617-773-5070
Mailing Address - Fax:617-472-2380
Practice Address - Street 1:191 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7751
Practice Address - Country:US
Practice Address - Phone:617-773-5070
Practice Address - Fax:617-472-2380
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075412OtherTUFHTS HEALTH PLAN
MA3092887Medicaid
MAJ12178OtherBLUE SHIELD OF MA
MA20728OtherHPHC
MA075412OtherTUFHTS HEALTH PLAN