Provider Demographics
NPI:1912965781
Name:MCGRATH, MARY H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:SUITE M-593 BOX #0932
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-353-4285
Mailing Address - Fax:415-353-4320
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-4389
Practice Address - Fax:415-353-4320
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86743208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G8674300Medicaid
CA0G8674300Medicare PIN
CAC09097Medicare UPIN