Provider Demographics
NPI:1861651432
Name:MCCUSKER, MEAGEN MARCY (MD)
Entity Type:Individual
Prefix:DR
First Name:MEAGEN
Middle Name:MARCY
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MEAGEN
Other - Middle Name:JEAN
Other - Last Name:MARCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 ELM STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-2225
Mailing Address - Fax:860-741-2229
Practice Address - Street 1:113 ELM STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-741-2225
Practice Address - Fax:860-741-2229
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050238207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology