Provider Demographics
NPI:1437383957
Name:MCLOUGHLIN, PATRICIA M (NPP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 NEW VERMONT RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12814-4015
Mailing Address - Country:US
Mailing Address - Phone:570-877-8700
Mailing Address - Fax:
Practice Address - Street 1:102 RACE TRACK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-4004
Practice Address - Country:US
Practice Address - Phone:518-585-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401199363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00630039Medicaid