Provider Demographics
NPI:1487612313
Name:MCKINNON, MONICA M (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FARM ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-1123
Mailing Address - Country:US
Mailing Address - Phone:617-894-3050
Mailing Address - Fax:888-600-8612
Practice Address - Street 1:35 FARM ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1123
Practice Address - Country:US
Practice Address - Phone:617-894-3050
Practice Address - Fax:888-600-8612
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159163207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA136994OtherHARVARD PILGRIM HEALTH CARE
MA159163OtherTUFT'S
5561765OtherAETNA
J21413OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA3196810Medicaid
MA4993918OtherCIGNA
MA3196810Medicaid
A29742Medicare PIN