Provider Demographics
NPI:1356493365
Name:MCSHANE, MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:396 TOM MILLER ROAD
Mailing Address - Street 2:UNIT B
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7704
Mailing Address - Country:US
Mailing Address - Phone:151-832-4554
Mailing Address - Fax:206-984-3043
Practice Address - Street 1:396 TOM MILLER RD
Practice Address - Street 2:UNIT B
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6430
Practice Address - Country:US
Practice Address - Phone:151-832-4554
Practice Address - Fax:206-984-3043
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY182311-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine