Provider Demographics
NPI:1316243587
Name:HENEGHAN, RICHARD KEVIN JR (RNNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KEVIN
Last Name:HENEGHAN
Suffix:JR
Gender:M
Credentials:RNNP
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Mailing Address - Street 1:2284 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3829
Mailing Address - Country:US
Mailing Address - Phone:978-369-5575
Mailing Address - Fax:978-371-9189
Practice Address - Street 1:2284 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3829
Practice Address - Country:US
Practice Address - Phone:978-369-5575
Practice Address - Fax:978-371-9189
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN188673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1316243587OtherNPI