Healthcare Provider Details

I. General information

NPI: 1487612313
Provider Name (Legal Business Name): MONICA M MCKINNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FARM ST
MEDFIELD MA
02052-1123
US

IV. Provider business mailing address

35 FARM ST
MEDFIELD MA
02052-1123
US

V. Phone/Fax

Practice location:
  • Phone: 617-894-3050
  • Fax: 888-600-8612
Mailing address:
  • Phone: 617-894-3050
  • Fax: 888-600-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number159163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: