Provider Demographics
NPI:1679517668
Name:MACGREGOR, DOUGLAS NEAL (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:NEAL
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST PEDIATRICS
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-7744
Mailing Address - Fax:207-664-7724
Practice Address - Street 1:32 RESORT WAY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1717
Practice Address - Country:US
Practice Address - Phone:207-664-7744
Practice Address - Fax:207-664-7724
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001349902Medicaid
CT001349902Medicaid
ME002042201Medicare PIN