Provider Demographics
NPI:1972944957
Name:STOCK, MEGAN S (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:STOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1964
Mailing Address - Country:US
Mailing Address - Phone:860-677-3950
Mailing Address - Fax:860-724-4397
Practice Address - Street 1:406 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1964
Practice Address - Country:US
Practice Address - Phone:860-677-3950
Practice Address - Fax:860-724-4397
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002926363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002926OtherSTATE LICENSE