Provider Demographics
NPI:1386270866
Name:MCDONOUGH, MADELINE J (MS, RDN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:J
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1208
Mailing Address - Country:US
Mailing Address - Phone:440-623-1233
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1262
Practice Address - Country:US
Practice Address - Phone:781-343-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered