Provider Demographics
NPI:1083910244
Name:GAZDA, MEGAN E
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:GAZDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EAST ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2224
Mailing Address - Country:US
Mailing Address - Phone:508-455-7208
Mailing Address - Fax:
Practice Address - Street 1:31 EAST ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2224
Practice Address - Country:US
Practice Address - Phone:508-455-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor