Healthcare Provider Details

I. General information

NPI: 1104493030
Provider Name (Legal Business Name): DEIRDRE MARIE MCCUE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. DEIRDRE MARIE HAYES

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

27 PRINCETON AVE
NORTH WEYMOUTH MA
02191-1113
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6428
  • Fax:
Mailing address:
  • Phone: 781-335-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberMA939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: