Provider Demographics
NPI:1417148636
Name:CONNORS, MEAGHAN L (MD)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:L
Last Name:CONNORS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1330 LINCOLN AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2143
Mailing Address - Country:US
Mailing Address - Phone:510-809-0160
Mailing Address - Fax:415-454-8591
Practice Address - Street 1:2001 DWIGHT WAY STE 4190
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4635
Practice Address - Fax:510-204-3060
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC560082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043904OtherPROFESSIONAL LICENSE
CTPENDING C00814Medicare PIN