Provider Demographics
NPI:1851410245
Name:MCCALLUM, MEGAN S (LIC AC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4822
Mailing Address - Country:US
Mailing Address - Phone:781-749-8088
Mailing Address - Fax:
Practice Address - Street 1:195 WHITING ST
Practice Address - Street 2:#4A
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3717
Practice Address - Country:US
Practice Address - Phone:781-749-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist