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 1:500 E WASHINGTON ST UNIT 14
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-6302
Mailing Address - Country:US
Mailing Address - Phone:774-306-4146
Mailing Address - Fax:401-496-9501
Practice Address - Street 1:500 E WASHINGTON ST UNIT 14
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6302
Practice Address - Country:US
Practice Address - Phone:774-306-4146
Practice Address - Fax:401-496-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1877332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70881OtherBLUE SHIELD
MA0362042Medicaid
MAT58805Medicare UPIN
MA0916920001Medicare NSC
MAMCY70881Medicare Oscar/Certification