Healthcare Provider Details

I. General information

NPI: 1336388677
Provider Name (Legal Business Name): MR. MICHAEL MCLAUGHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14A TSIENNETO RD
DERRY NH
03038-1505
US

IV. Provider business mailing address

14B TSIENNETO RD
DERRY NH
03038-1505
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1300
  • Fax: 603-845-5135
Mailing address:
  • Phone: 603-537-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP131088
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number060533-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN53381
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: