Provider Demographics
NPI:1285260323
Name:MACKILLOP, MAGGIE
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:MACKILLOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NH
Mailing Address - Zip Code:03449-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-7344
Practice Address - Country:US
Practice Address - Phone:603-542-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1355208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation