Provider Demographics
NPI:1285642082
Name:MCGINN, CORNELIUS J (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:J
Last Name:MCGINN
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 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD162112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0050Medicare PIN
MEME005002Medicare PIN
ME0007145447OtherAETNA/USHC
P00046336OtherRAILROAD MEDICARE
ME257400099Medicaid
ME035178OtherCIGNA
MEG19339Medicare UPIN
NH30204016Medicaid
MEME005004Medicare PIN
ME035178OtherANTHEM
MEME005003Medicare PIN
ME13028OtherHPHC
ME3206766OtherAETNA
ME005001Medicare PIN