Provider Demographics
NPI:1306693965
Name:MCGONAGLE, PHILIP S
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:MCGONAGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CEDAR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2909
Mailing Address - Country:US
Mailing Address - Phone:339-235-5801
Mailing Address - Fax:
Practice Address - Street 1:105 CEDAR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2909
Practice Address - Country:US
Practice Address - Phone:339-235-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide