Provider Demographics
NPI:1609898931
Name:MCCANTY, MAUREEN E
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:E
Last Name:MCCANTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5046
Mailing Address - Country:US
Mailing Address - Phone:603-228-1111
Mailing Address - Fax:603-226-4314
Practice Address - Street 1:189 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5046
Practice Address - Country:US
Practice Address - Phone:603-228-1111
Practice Address - Fax:603-226-4314
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH6594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH83163612Medicaid
NHRE0607Medicare ID - Type Unspecified
NH83163612Medicaid