Healthcare Provider Details

I. General information

NPI: 1194257485
Provider Name (Legal Business Name): SEAN ORIN MACKINTOSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREDERICK ABBOTT WAY
FRAMINGHAM MA
01701-7992
US

IV. Provider business mailing address

1 FREDERICK ABBOTT WAY
FRAMINGHAM MA
01701-7992
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-9800
  • Fax: 508-875-1348
Mailing address:
  • Phone: 508-879-9800
  • Fax: 508-875-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number306298
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number291238
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier2441086
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: