Healthcare Provider Details

I. General information

NPI: 1750747069
Provider Name (Legal Business Name): MEGHAN KATHLEEN MCGONAGLE MAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 FRENCH ST
HINGHAM MA
02043-3029
US

IV. Provider business mailing address

14 FRENCH ST
HINGHAM MA
02043-3029
US

V. Phone/Fax

Practice location:
  • Phone: 617-650-5715
  • Fax:
Mailing address:
  • Phone: 617-650-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: