Provider Demographics
NPI:1841248465
Name:MCCLUSKEY, MARJORIE J (NP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:J
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 WEBSTER ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-754-6545
Mailing Address - Fax:781-536-0016
Practice Address - Street 1:105 WEBSTER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-754-6545
Practice Address - Fax:781-536-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA182270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082935AMedicaid
MA110082935AMedicaid
MANP0949Medicare ID - Type Unspecified