Healthcare Provider Details

I. General information

NPI: 1407136112
Provider Name (Legal Business Name): LAWRENCE E. MCGINNESS, D.P.M., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CUMMINGS CTR SUITE 119-W
BEVERLY MA
01915-6198
US

IV. Provider business mailing address

900 CUMMINGS CTR SUITE 119-W
BEVERLY MA
01915-6198
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-0288
  • Fax: 978-927-6265
Mailing address:
  • Phone: 978-922-0288
  • Fax: 978-927-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1520
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1520
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1520
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1520
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1520
License Number StateMA

VIII. Authorized Official

Name: DR. LAWRENCE EDWARD MCGINNESS
Title or Position: OWNER
Credential: D.P.M.
Phone: 978-922-0288