Provider Demographics
NPI:1760652234
Name:MCNALLY, MEGAN DUFFY (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:DUFFY
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:MEGAN
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:5005 S 40TH ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2969
Practice Address - Country:US
Practice Address - Phone:602-453-7130
Practice Address - Fax:310-698-7054
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4816207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47978OtherPHYSICIAN LICENSE
UT7405355-1204OtherPHYSICIAN LICENSE
AZR874OtherTRAINING PERMIT
AZ4816OtherPHYSICIAN LICENSE
NE680OtherPHYSICIAN LICENSE
SD7888OtherPHYSICIAN LICENSE
WY8345AOtherPHYSICIAN LICENSE
NVDO1506OtherPHYSICIAN LICENSE
IDO-0571OtherPHYSICIAN LICENSE