Provider Demographics
NPI:1629296439
Name:MACGREGOR, MARY IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:IRENE
Last Name:MACGREGOR
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 1:700 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2104
Mailing Address - Country:US
Mailing Address - Phone:410-662-4390
Mailing Address - Fax:410-235-7425
Practice Address - Street 1:700 W 40TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2104
Practice Address - Country:US
Practice Address - Phone:410-662-4390
Practice Address - Fax:410-235-7425
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013657207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD57615Medicare UPIN
MDK791BM02Medicare PIN