Provider Demographics
NPI:1295846715
Name:MCLOUGHLIN, KATHLEEN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5224
Mailing Address - Country:US
Mailing Address - Phone:209-722-9066
Mailing Address - Fax:209-383-1522
Practice Address - Street 1:535 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2801
Practice Address - Country:US
Practice Address - Phone:209-722-9066
Practice Address - Fax:209-383-1522
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G706700Medicaid
CAF22702Medicare UPIN
CA00G706700Medicare PIN