Basic Information
| Provider Information | |||||||||
| NPI: | 1699769679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCHUGH | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951427 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144578180 | ||||||||
| FaxNumber: | 6144422414 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S CLEVELAND AVE | ||||||||
| Address2: | ST. ANN'S HOSPITAL PATHOLOGY DEPT | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148985568 | ||||||||
| FaxNumber: | 6148988633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 11/01/2010 | ||||||||
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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 | 207ZP0102X | 35081312 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 2327691 | 05 | OH | MEDICAID |