Provider Demographics
NPI:1790705457
Name:MCLAUGHLIN, E. KELLY (DPM)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:KELLY
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:140 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:508-223-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1877213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0362042Medicaid
MAY70881OtherBLUE SHIELD
MAT58805Medicare UPIN
MA0916920001Medicare NSC
MAMCY70881Medicare Oscar/Certification