Provider Demographics
NPI:1700113024
Name:MCGILLIGAN, BECKY (MD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:MCGILLIGAN
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 1:7529 STATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6410
Mailing Address - Country:US
Mailing Address - Phone:513-715-5044
Mailing Address - Fax:513-725-2229
Practice Address - Street 1:7529 STATE RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6410
Practice Address - Country:US
Practice Address - Phone:513-715-5044
Practice Address - Fax:513-725-2229
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067507Medicaid
OH0067507Medicaid