Provider Demographics
NPI:1003902404
Name:PRENTISS, MEGHAN ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANNE
Last Name:PRENTISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILL LN
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1347
Mailing Address - Country:US
Mailing Address - Phone:781-659-2128
Mailing Address - Fax:
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000494501Medicare PIN
ME000494502Medicare PIN