Provider Demographics
NPI:1235704115
Name:OBERLY, MEGHAN LISA (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LISA
Last Name:OBERLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-545-5000
Mailing Address - Fax:860-545-5066
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-545-5000
Practice Address - Fax:860-545-5066
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-12-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant