Healthcare Provider Details

I. General information

NPI: 1912965781
Provider Name (Legal Business Name): MARY H. MCGRATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY SIMON

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE SUITE 509
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

505 PARNASSUS AVE SUITE M-593 BOX #0932
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4389
  • Fax: 415-353-4320
Mailing address:
  • Phone: 415-353-4285
  • Fax: 415-353-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG86743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG86743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: