Healthcare Provider Details

I. General information

NPI: 1780658427
Provider Name (Legal Business Name): JOHN P. MCLOUGHLIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 OAK ST SUITE 222E
BROCKTON MA
02301-1168
US

IV. Provider business mailing address

34 LEE ST
BOSTON MA
02130-3251
US

V. Phone/Fax

Practice location:
  • Phone: 508-586-4444
  • Fax: 508-586-4709
Mailing address:
  • Phone: 617-524-0322
  • Fax: 617-524-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPD 1969
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD 1969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: