Provider Demographics
NPI:1518928449
Name:SCANNELL, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:SCANNELL
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 1:140 W BOYLSTON DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2726
Mailing Address - Country:US
Mailing Address - Phone:508-853-6662
Mailing Address - Fax:
Practice Address - Street 1:140 W BOYLSTON DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2726
Practice Address - Country:US
Practice Address - Phone:508-853-6662
Practice Address - Fax:508-853-6860
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3030598Medicaid
MAA59286Medicare UPIN
MA3030598Medicaid