Provider Demographics
NPI:1578098810
Name:MCGREGOR, MARYELLENY JAMSION (MD)
Entity Type:Individual
Prefix:
First Name:MARYELLENY
Middle Name:JAMSION
Last Name:MCGREGOR
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:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1084
Mailing Address - Country:US
Mailing Address - Phone:336-716-2832
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF FAMILY MEDICINE
Practice Address - Street 2:MEDICAL CENTER BOULEVARD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1084
Practice Address - Country:US
Practice Address - Phone:336-716-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine