Provider Demographics
NPI:1861488967
Name:MCCRARY, PHILLIP D (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:MCCRARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1905
Mailing Address - Country:US
Mailing Address - Phone:781-263-9115
Mailing Address - Fax:
Practice Address - Street 1:30 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1905
Practice Address - Country:US
Practice Address - Phone:781-263-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA368734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA35740Medicare UPIN
MAB33523Medicare ID - Type UnspecifiedMEDICARE & BS