Provider Demographics
NPI:1669633251
Name:PANICO, MEGAN (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PANICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 HAZARD AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5447
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6811
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 923
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-547-1876
Practice Address - Fax:860-520-1379
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2020-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT049581207R00000X
CT49581207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT49581OtherLICENSE