Provider Demographics
NPI:1699762864
Name:GAUGHAN, MAUREEN ANN (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:GAUGHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-2650
Practice Address - Street 1:5 TARKILN ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1250
Practice Address - Country:US
Practice Address - Phone:781-585-1784
Practice Address - Fax:781-585-2200
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA92659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0391000Medicaid
MASS0058OtherBCBSMA
MA0391000Medicaid
S37107Medicare UPIN