Provider Demographics
NPI:1700539277
Name:MCGONAGLE, MEG ELIZABETH
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:ELIZABETH
Last Name:MCGONAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:ELIZABETH
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1827
Mailing Address - Country:US
Mailing Address - Phone:413-528-8600
Mailing Address - Fax:
Practice Address - Street 1:20 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1827
Practice Address - Country:US
Practice Address - Phone:413-528-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86243058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered