Healthcare Provider Details

I. General information

NPI: 1568434876
Provider Name (Legal Business Name): CAROLYN A MONGEON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND AVE CHARLTON HOSPITAL
FALL RIVER MA
02720-3703
US

IV. Provider business mailing address

70 WATUPPA RD
WESTPORT MA
02790-4620
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-7398
  • Fax:
Mailing address:
  • Phone: 508-916-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number80749
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number80749
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: