Provider Demographics
NPI:1346295375
Name:GALVIN, MARA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:C
Last Name:GALVIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20 NE SAINT LUKES BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6001
Mailing Address - Country:US
Mailing Address - Phone:816-282-7809
Mailing Address - Fax:816-282-7870
Practice Address - Street 1:20 NE SAINT LUKES BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6001
Practice Address - Country:US
Practice Address - Phone:816-282-7809
Practice Address - Fax:816-282-7870
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3E90207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208234302Medicaid
MOA98255Medicare UPIN
MO208234302Medicaid