Provider Demographics
NPI:1366524696
Name:MCHUGH, JOAN M
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:M
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:1360 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6301
Practice Address - Country:US
Practice Address - Phone:014-606-3110
Practice Address - Fax:508-764-5458
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02299363L00000X
MA149489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354481Medicaid
MANP3362OtherBCBS #
MAP35833Medicare UPIN
MAMCNP3362Medicare ID - Type UnspecifiedMEDICARE #