Healthcare Provider Details

I. General information

NPI: 1982608667
Provider Name (Legal Business Name): JOHN M MCHUGH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ECHO LAKE RD UNIT F
WATERTOWN CT
06795-6618
US

IV. Provider business mailing address

777 ECHO LAKE RD UNIT F
WATERTOWN CT
06795-6618
US

V. Phone/Fax

Practice location:
  • Phone: 860-274-1773
  • Fax: 860-945-6820
Mailing address:
  • Phone: 860-274-1773
  • Fax: 860-945-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP00393
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: