Healthcare Provider Details

I. General information

NPI: 1619414505
Provider Name (Legal Business Name): E KELLY MCLAUGHLIN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WASHINGTON ST UNIT 14
NORTH ATTLEBORO MA
02760-6302
US

IV. Provider business mailing address

500 E WASHINGTON ST UNIT 14
NORTH ATTLEBORO MA
02760-6302
US

V. Phone/Fax

Practice location:
  • Phone: 774-306-4146
  • Fax: 401-496-9501
Mailing address:
  • Phone: 774-306-4146
  • Fax: 401-496-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMA1877
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MCLAUGHLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-335-3296