Provider Demographics
NPI:1790890440
Name:MCNALLY, JANE DASEY (DO)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:DASEY
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-822-9898
Mailing Address - Fax:207-822-9899
Practice Address - Street 1:650 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1035
Practice Address - Country:US
Practice Address - Phone:207-822-9898
Practice Address - Fax:207-822-9899
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02051Medicare UPIN