Provider Demographics
NPI:1528194172
Name:MACGREGOR, MARY E (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:MACGREGOR
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-961-5919
Practice Address - Fax:508-961-5916
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA258696363L00000X
MARN258696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0712647Medicaid
MA000045401Medicare PIN
Q79317Medicare UPIN