Provider Demographics
NPI:1164769121
Name:DATTOLI, MEGAN
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:DATTOLI
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 1:61 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3330
Mailing Address - Country:US
Mailing Address - Phone:617-852-4153
Mailing Address - Fax:
Practice Address - Street 1:61 CARROLL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3330
Practice Address - Country:US
Practice Address - Phone:617-852-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula