Provider Demographics
NPI:1679684864
Name:MCGONEGAL, NANCY L
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:MCGONEGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 344-E
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-927-0749
Mailing Address - Fax:610-621-4087
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 344-E
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-927-0749
Practice Address - Fax:610-621-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0440910001Medicare ID - Type Unspecified