Provider Demographics
NPI:1053327791
Name:MISTRY, MEGAN R (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:R
Last Name:MISTRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2690
Mailing Address - Country:US
Mailing Address - Phone:781-449-0020
Mailing Address - Fax:781-449-3181
Practice Address - Street 1:1450 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2690
Practice Address - Country:US
Practice Address - Phone:781-449-0020
Practice Address - Fax:781-449-3181
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J23060OtherBLUE CROSS
H16502Medicare UPIN
J23060OtherBLUE CROSS