Provider Demographics
NPI:1952644429
Name:MCTAGUE, MAURA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:ROSE
Last Name:MCTAGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 ARLINGTON AVE
Mailing Address - Street 2:APARTMENT 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1503
Mailing Address - Country:US
Mailing Address - Phone:917-376-7031
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY309885207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program