1386829349 NPI number — MS. MAUREEN ANN MCDONAGH RD

Table of content: MS. MAUREEN ANN MCDONAGH RD (NPI 1386829349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386829349 NPI number — MS. MAUREEN ANN MCDONAGH RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONAGH
Provider First Name:
MAUREEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROZES
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386829349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 THAMES ST.
Provider Second Line Business Mailing Address:
#445
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-855-5885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 BEACH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-855-5885
Provider Business Practice Location Address Fax Number:
401-781-3375
Provider Enumeration Date:
01/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LDN00611 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)