Active NPI
Mary Ellen Dugan, M.D.
- Pediatrics Physician
- Southborough, MA
National Provider Identifier
1497773972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 57233
- Practice address
- 24 Newton St
Southborough, MA 01772-1215 - Phone
- (508) 460-3100
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 57233 | MA | Primary |
Addresses
Primary practice location
24 Newton St
Southborough, MA 01772-1215
Mailing address
24 Newton St
Southborough, MA 01772
Phone (508) 460-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3017109 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57233 | MA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497773972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 NEWTON ST",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "01772",
"telephone_number": "508-460-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 NEWTON ST",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721215",
"telephone_number": "508-460-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUGAN",
"first_name": "MARY ELLEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "57233",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3017109",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.