MEDICARE: DR. WINSTON MCGILL JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	25MA03335700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093810749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSTON MCGILL JR. MD

Provider Business Mailing Address
First Line	:	258 CENTRAL AVE
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3414
Country	:	US
Telephone Number	:	973-677-1144
Fax Number	:	973-677-9145

Provider Business Practice Location Address
First Line	:	258 CENTRAL AVE
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3414
Country	:	US
Telephone Number	:	973-677-1144
Fax Number	:	973-677-9145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/31/2012

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