Healthcare Provider Details

I. General information

NPI: 1487924445
Provider Name (Legal Business Name): JULIE MARIE MCGONDEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE JAMGOCHIAN

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 02/12/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DAN ROAD
CANTON MA
02021
US

IV. Provider business mailing address

6 GREENWOOD AVENUE
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 781-867-2050
  • Fax: 978-794-2007
Mailing address:
  • Phone: 857-327-5347
  • Fax: 508-230-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2259262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: