Provider Demographics
NPI:1194798587
Name:MCKEE, ANN C (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GLEZEN LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1508
Mailing Address - Country:US
Mailing Address - Phone:781-687-2913
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGS ROAD
Practice Address - Street 2:182-B
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:781-687-2913
Practice Address - Fax:781-687-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56282207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074277Medicaid
MAJ10804Medicare ID - Type Unspecified
MA3074277Medicaid