Provider Demographics
NPI:1679774988
Name:MCKENDALL, MARY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:MCKENDALL
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:ONE ENTERPRISE DRIVE
Mailing Address - Street 2:BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-246-9922
Mailing Address - Fax:
Practice Address - Street 1:ONE ENTERPRISE DRIVE
Practice Address - Street 2:BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-246-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49861207R00000X
RIMD06152207R00000X
CT023987207R00000X
PAMD027333E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine