Healthcare Provider Details

I. General information

NPI: 1235180969
Provider Name (Legal Business Name): MARY E MCGUIGGIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E MULRYAN MD

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEATHERWOOD LN NW
LOS RANCHOS NM
87107-6438
US

IV. Provider business mailing address

901 LEATHERWOOD LN NW
LOS RANCHOS NM
87107-6438
US

V. Phone/Fax

Practice location:
  • Phone: 505-918-4777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD2006-0270
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: