=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467982413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVICULAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 PARK ST STE 1
-----------------------------------------------------
City | ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02703-8048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-226-8070
-----------------------------------------------------
Fax | 508-223-3498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 PARK ST STE 1
-----------------------------------------------------
City | ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02703-8048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-226-8070
-----------------------------------------------------
Fax | 508-223-3498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWIN KELLY MCLAUGHLIN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 508-226-8070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | MA1877
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------