Provider Demographics
NPI:1710169487
Name:E.KELLY MCLAUGHLIN, D.P.M.
Entity Type:Organization
Organization Name:E.KELLY MCLAUGHLIN, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M.
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Practice Address - Street 1:140 PARK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3064
Practice Address - Country:US
Practice Address - Phone:508-226-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1877213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y70881OtherBLUE SHIELD
MA0362042Medicaid
MA0362042Medicaid
MAT58805Medicare UPIN
MA0916920001Medicare NSC