MEDICARE: JOSEPH MCDONOUGH

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	251E00000X	Home Health Agency		MA

General Provider Information

NPI Number	:	1639556327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MCDONOUGH

Provider Business Mailing Address
First Line	:	2 CANTON ST
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2867
Country	:	US
Telephone Number	:	781-341-1246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CANTON ST STE A300
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2867
Country	:	US
Telephone Number	:	781-341-1246
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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Directions to “ JOSEPH MCDONOUGH ” Practice Location

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