Provider Demographics
NPI:1578602231
Name:MCGAUGHAN, JAMES RAYMOND JR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAYMOND
Last Name:MCGAUGHAN
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:306 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1469
Mailing Address - Country:US
Mailing Address - Phone:718-885-3619
Mailing Address - Fax:
Practice Address - Street 1:2157 TOMLINSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1267
Practice Address - Country:US
Practice Address - Phone:718-794-2501
Practice Address - Fax:718-794-2510
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005092-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5186LEY191Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER