Provider Demographics
NPI:1447694864
Name:MCELLIGOTT, KEVIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MCELLIGOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:211 MOUNTAIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2221
Practice Address - Country:US
Practice Address - Phone:973-467-0005
Practice Address - Fax:973-912-8989
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-00962207RC0000X
390200000X
NJ25MA11633600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program