Provider Demographics
NPI:1285693150
Name:MCGRORY, DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MCGRORY
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 1:45 COLPITTS ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493
Mailing Address - Country:US
Mailing Address - Phone:781-899-7778
Mailing Address - Fax:781-899-0475
Practice Address - Street 1:45 COLPITTS ROAD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493
Practice Address - Country:US
Practice Address - Phone:781-899-7778
Practice Address - Fax:781-899-0475
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58792207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10394Medicare UPIN
J08683Medicare ID - Type Unspecified