Healthcare Provider Details

I. General information

NPI: 1720078066
Provider Name (Legal Business Name): MICHAEL M MCLEOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FARRINGTON CORNER RD
HOPKINTON NH
03229-2020
US

IV. Provider business mailing address

19 FARRINGTON CORNER RD
HOPKINTON NH
03229-2020
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7575
  • Fax: 603-228-7585
Mailing address:
  • Phone: 603-228-7575
  • Fax: 603-228-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11968
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: