Provider Demographics
NPI:1235249137
Name:STATON, MEGAN A (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:STATON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 FODEN RD. WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:100 FODEN RD EAST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2327
Practice Address - Country:US
Practice Address - Phone:207-874-1489
Practice Address - Fax:207-523-8590
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-05-26
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Provider Licenses
StateLicense IDTaxonomies
ME016981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESX4535Medicare PIN