Provider Demographics
NPI:1649388612
Name:DOUGLAS, MEGAN P (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:P
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1227
Mailing Address - Country:US
Mailing Address - Phone:508-336-9200
Mailing Address - Fax:508-336-9303
Practice Address - Street 1:538 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1227
Practice Address - Country:US
Practice Address - Phone:508-336-9200
Practice Address - Fax:508-336-9303
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208027207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA692785OtherHPHC
39495OtherUHC
413179OtherRI BLUE CHIP
MA000000032092OtherBMC HEALTHNET
MA208027OtherTUFTS
MA0198072Medicaid
MA53999OtherFALLON
MA1841404001OtherCIGNA
MAJ24723OtherMABC
MA1841404001OtherCIGNA
MAH55202Medicare UPIN