Healthcare Provider Details

I. General information

NPI: 1760481733
Provider Name (Legal Business Name): MAURA MCGRANE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST STE 2001
BEVERLY MA
01915-2757
US

IV. Provider business mailing address

83 HERRICK ST #2001
BEVERLY MA
01915-2757
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-9778
  • Fax: 978-922-3878
Mailing address:
  • Phone: 978-922-9778
  • Fax: 978-922-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MAURA F MCGRANE
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 978-922-9778