Provider Demographics
NPI:1013950252
Name:CONOLLY, MARGARET ANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANNE
Last Name:CONOLLY
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:POST OFFICE BOX 76
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:NM
Mailing Address - Zip Code:87714
Mailing Address - Country:US
Mailing Address - Phone:505-376-2065
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ROAD
Practice Address - Street 2:BOX 6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-5857
Practice Address - Fax:505-758-2832
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI54462084P0800X
NMMD2006-01372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21678251Medicaid
NMC67303Medicare UPIN