Provider Demographics
NPI:1982717807
Name:MCGONIGLE, JOHN DERMOTT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DERMOTT
Last Name:MCGONIGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3522
Mailing Address - Country:US
Mailing Address - Phone:401-572-3300
Mailing Address - Fax:401-572-3301
Practice Address - Street 1:201 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3522
Practice Address - Country:US
Practice Address - Phone:401-572-3300
Practice Address - Fax:401-572-3301
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine