Provider Demographics
NPI:1003902404
Name:PRENTISS, MEGHAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:PRENTISS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 STOCKADE PATH
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4627
Mailing Address - Country:US
Mailing Address - Phone:781-585-2827
Mailing Address - Fax:
Practice Address - Street 1:45 RESNIK RD STE 205
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7223
Practice Address - Country:US
Practice Address - Phone:508-746-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000494501Medicare PIN
ME000494502Medicare PIN