Provider Demographics
NPI:1710258371
Name:GRADY, MEGAN LEAHY (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEAHY
Last Name:GRADY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4204
Mailing Address - Country:US
Mailing Address - Phone:203-206-8882
Mailing Address - Fax:
Practice Address - Street 1:165 CAMBRIDGE ST.
Practice Address - Street 2:CHARLES RIVER PLAZA 5TH FLOOR MGH SENIOR HEALTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265182363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health