Healthcare Provider Details

I. General information

NPI: 1952369175
Provider Name (Legal Business Name): SHARON ANNE MACMILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SILVER STREET SUITE 214
AGAWAM MA
01001
US

IV. Provider business mailing address

200 SILVER STREET SUITE 214
AGAWAM MA
01001
US

V. Phone/Fax

Practice location:
  • Phone: 413-209-9394
  • Fax: 413-209-8579
Mailing address:
  • Phone: 413-209-9394
  • Fax: 413-209-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number204995
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number204995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: