Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 49953 | MA |
NPI | 1164517538 |
---|---|
Provider Name | Dr. Ann R Mcgravey |
First Address | North Andover, MA 01845 |
Second Address | North Andover, MA 01845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D88179 | (02) | MA |