MEDICARE: BENJAMIN MCLAUGHLIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	276778	NY
2	207Q00000X	Family Medicine Physician	OP60609109	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400117889	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336435049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MCLAUGHLIN D.O.

Provider Business Mailing Address
First Line	:	1400 E. KINCAID STREET
Second Line	:	ATTN: CREDENTIALING
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-814-6724
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 S 13TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4112
Country	:	US
Telephone Number	:	360-814-6230
Fax Number	:	360-814-6240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	12/13/2017

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