Provider Demographics
NPI:1093995979
Name:LEARY, MEGHAN (CRNA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-384-3072
Mailing Address - Fax:
Practice Address - Street 1:7365 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1300
Practice Address - Country:US
Practice Address - Phone:800-586-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT073383367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicare PIN