Basic Information
| Provider Information | |||||||||
| NPI: | 1528194172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACGREGOR | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL RD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PAGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027403464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089615919 | ||||||||
| FaxNumber: | 5089615916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 258696 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | RN258696 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0712647 | 05 | MA | MEDICAID |