Healthcare Provider Details

I. General information

NPI: 1609857861
Provider Name (Legal Business Name): AISLING GAUGHAN M.D., F.A.A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THOREAU ST
CONCORD MA
01742-2443
US

IV. Provider business mailing address

PO BOX 414559
BOSTON MA
02241-4559
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-9401
  • Fax: 978-371-8810
Mailing address:
  • Phone: 978-369-9401
  • Fax: 978-371-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78533
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: