Provider Demographics
NPI:1922092949
Name:MACGAW, DOUGLAS MERRITT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MERRITT
Last Name:MACGAW
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 1:2860 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-8090
Mailing Address - Country:US
Mailing Address - Phone:901-252-6034
Mailing Address - Fax:901-252-6048
Practice Address - Street 1:2860 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-8090
Practice Address - Country:US
Practice Address - Phone:901-252-6034
Practice Address - Fax:901-252-6048
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07103208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159338Medicaid
B02770Medicare UPIN