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General NPI Number Information
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NPI Number | 1972590784
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Entity Type | Individual
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Provider Name | JOHN VINCENT COONEY M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 114 WHITWELL ST
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City | QUINCY
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State | MA
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Zip | 02169-1870
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Country | US
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Telephone | 617-376-4058
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Fax | 617-376-1641
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Provider Business Mailing Address
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Address Line | 4 WILSON ST
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City | MEDFIELD
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State | MA
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Zip | 02052-3226
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Country | US
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Telephone | 508-359-9746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 70318
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License Number State | MA
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