41D1101912 CLIA NUMBER - JOHN MCGONIGLE MD

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Laboratory Demographics

CLIA Number: 41D1101912

Facility Name: JOHN MCGONIGLE MD

Facility Address:
201 WATERMAN AVE
EAST PROVIDENCE, RI
ZIP 02914
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Facility Phone Number: 401 447-2464

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982717807

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	41D1101912
LAB Type	Physician Office
Facility Name	JOHN MCGONIGLE MD
Street	201 WATERMAN AVE
City	EAST PROVIDENCE
State	RI
ZIP	02914
Phone	401 447-2464
CertificateType	4
CertificateEffectiveDate	7/8/2023
CertificateExpirationDate	7/7/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024