Provider Demographics
NPI:1255660247
Name:MASK, MEGAN ARTHUR (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ARTHUR
Last Name:MASK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BUXTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1224
Mailing Address - Country:US
Mailing Address - Phone:203-322-7070
Mailing Address - Fax:203-322-2389
Practice Address - Street 1:30 BUXTON FARM RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1224
Practice Address - Country:US
Practice Address - Phone:203-322-7070
Practice Address - Fax:203-322-2389
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005657363AM0700X
IL085004279363AM0700X
CT3077363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005657OtherGA LICENSE
IL085004279OtherIL LICENSE
IL2234308OtherBCBS
CT3077OtherCT LICENSE
CT3077OtherCT LICENSE