Provider Demographics
NPI:1568558930
Name:MARY E SCANNELL MD PC
Entity Type:Organization
Organization Name:MARY E SCANNELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-853-6662
Mailing Address - Street 1:140 WEST 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 WEST 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0017847OtherNHP GROUP PROVIDER ID
MACK8091OtherRAILROAD MEDICARE GROUP #
MA8510OtherFALLON VENDOR ID
MAM15675OtherBC/BS GROUP PROVIDER ID
MA607331OtherTUFTS GROUP PAYEE ID
MA9769498Medicaid
MA607331OtherTUFTS GROUP PAYEE ID