Provider Demographics
NPI:1417346404
Name:MACNAUGHTON, WARREN (LAC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MACNAUGHTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 AVIATION RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2900
Mailing Address - Country:US
Mailing Address - Phone:518-791-1779
Mailing Address - Fax:
Practice Address - Street 1:366 AVIATION RD
Practice Address - Street 2:SUITE 2
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2900
Practice Address - Country:US
Practice Address - Phone:518-791-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist