Provider Demographics
NPI:1619414505
Name:E KELLY MCLAUGHLIN DPM
Entity Type:Organization
Organization Name:E KELLY MCLAUGHLIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-226-8070
Mailing Address - Street 1:140 PARK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3064
Mailing Address - Country:US
Mailing Address - Phone:508-226-8070
Mailing Address - Fax:508-223-3498
Practice Address - Street 1:40 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2074
Practice Address - Country:US
Practice Address - Phone:508-543-0094
Practice Address - Fax:508-223-3498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E KELLY MCLAUGHLIN DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1877213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty