Provider Demographics
NPI:1851491120
Name:NALLY, MARGARET (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:NALLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1211
Mailing Address - Country:US
Mailing Address - Phone:617-354-5485
Mailing Address - Fax:
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:HVMA OB-GYN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1191
Practice Address - Fax:617-421-5828
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132487367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0368521Medicaid
MACN0180OtherBCBS
MAGROUP #OtherPHCS
MA8594271-001OtherCIGNA; HEALTHSOURCE
MAF212OtherHPHC
MARN0053Medicare ID - Type Unspecified