Healthcare Provider Details

I. General information

NPI: 1801075593
Provider Name (Legal Business Name): NANCY L. MCGONEGAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 344E
BEVERLY MA
01915-6136
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 344E
BEVERLY MA
01915-6136
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-0749
  • Fax:
Mailing address:
  • Phone: 978-927-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY L. MCGONEGAL
Title or Position: PRESIDENT
Credential:
Phone: 937-927-0749