Healthcare Provider Details

I. General information

NPI: 1376073940
Provider Name (Legal Business Name): MARGARET ANN GAUGHRAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 SOUTHERN BLVD
BRONX NY
10459-2417
US

IV. Provider business mailing address

1000 MONTAUK HIGHWAY PEDIATRICS DEPARTMENT
WEST ISLIP NY
11795
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-2440
  • Fax:
Mailing address:
  • Phone: 631-376-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number303116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: