Provider Demographics
NPI:1104177641
Name:CONNOLLY, MARGARET (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 TREMONT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2721
Mailing Address - Country:US
Mailing Address - Phone:781-662-7246
Mailing Address - Fax:781-662-7241
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-662-7246
Practice Address - Fax:781-662-7241
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN164743363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health