Healthcare Provider Details

I. General information

NPI: 1992753743
Provider Name (Legal Business Name): ALLISON MCCRORY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SEWALL ST
PORTLAND ME
04102-2645
US

IV. Provider business mailing address

50 SEWALL ST
PORTLAND ME
04102-2645
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3526
  • Fax: 207-775-5658
Mailing address:
  • Phone: 207-775-3526
  • Fax: 207-775-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD19205
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number38774
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: