Provider Demographics
NPI:1598780231
Name:MCGONAGLE, MATTHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:MCGONAGLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:186 STRATFORD ST
Mailing Address - Street 2:#1
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2141
Mailing Address - Country:US
Mailing Address - Phone:617-469-5385
Mailing Address - Fax:617-636-4852
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-469-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2234592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry