Provider Demographics
NPI:1487680427
Name:NAGLE, DEBORAH ANN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:NAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:STONEMAN 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-4179
Mailing Address - Fax:617-667-2978
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:STONEMAN 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-4159
Practice Address - Fax:617-667-2978
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA079886208C00000X
PAMD043640L208C00000X
MA229284208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA229284OtherMASS MEDICAL LICENSING BOARD
F80826Medicare UPIN