Healthcare Provider Details

I. General information

NPI: 1346296522
Provider Name (Legal Business Name): SIOBHAN M MCNALLY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 MAIN ST
SPRINGFIELD MA
01103-2114
US

IV. Provider business mailing address

1049 MAIN ST
SPRINGFIELD MA
01103-2114
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-1100
  • Fax: 413-735-1133
Mailing address:
  • Phone: 413-739-1100
  • Fax: 413-735-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56158
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110028120
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: