Basic Information
| Provider Information | |||||||||
| NPI: | 1609843598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONAGH | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088982338 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088982338 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 03/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 156420 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 33750 | 01 | FALLON COMMUNITY HEALTH P | OTHER | J19162 | 01 | BLUE SHIELD IDEMNITY | OTHER | 784160 | 01 | MVP HEALTH CARE | OTHER | 110059991A | 05 | MA | MEDICAID | 37276 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | AA1258 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 8681031 | 01 | CIGNA HEALTH PLAN | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 3181740 | 01 | HEALTHY START | OTHER | 7689513 | 01 | AETNA US HEALTHCARE | OTHER | A28407 | 01 | MEDICARE B | OTHER | J19162 | 01 | BLUE SHIELD HMO BLUE | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 2039844 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | J19162 | 01 | BLUE CARE ELECT | OTHER |