Healthcare Provider Details

I. General information

NPI: 1679517668
Provider Name (Legal Business Name): DOUGLAS NEAL MACGREGOR M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RESORT WAY
ELLSWORTH ME
04605-1717
US

IV. Provider business mailing address

50 UNION ST MAINE COAST PEDIATRICS
ELLSWORTH ME
04605-1534
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-7744
  • Fax: 207-664-7724
Mailing address:
  • Phone: 207-664-7744
  • Fax: 207-664-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034990
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: