Healthcare Provider Details

I. General information

NPI: 1003856659
Provider Name (Legal Business Name): BRIAN TODD MCKINLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY STE 403
DOVER NH
03820-5933
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-6664
  • Fax:
Mailing address:
  • Phone: 617-643-8315
  • Fax: 941-761-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number21360
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME 97774
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number33133
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: