1235180969 NPI number — MARY E MCGUIGGIN MD

Table of content: MARY E MCGUIGGIN MD (NPI 1235180969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235180969 NPI number — MARY E MCGUIGGIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUIGGIN
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULRYAN
Provider Other First Name:
MARY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235180969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 LEATHERWOOD LN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS RANCHOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107-6438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 LEATHERWOOD LN NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS RANCHOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-6438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-918-4777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MD2006-0270 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19404506 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com