Provider Demographics
NPI:1346296522
Name:MCNALLY, SIOBHAN M (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:M
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2114
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-735-1133
Practice Address - Street 1:1049 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2114
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-735-1133
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56158208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028120Medicaid
MAM21172Medicare UPIN
MA221883Medicare Oscar/Certification
MA221829Medicare Oscar/Certification