Provider Demographics
NPI:1609857861
Name:GAUGHAN, AISLING (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:AISLING
Middle Name:
Last Name:GAUGHAN
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414559
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4559
Mailing Address - Country:US
Mailing Address - Phone:978-369-9401
Mailing Address - Fax:978-371-8810
Practice Address - Street 1:101 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2443
Practice Address - Country:US
Practice Address - Phone:978-369-9401
Practice Address - Fax:978-371-8810
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E68914Medicare UPIN
MA9731270Medicare ID - Type Unspecified
MAJ14227Medicare PIN