Provider Demographics
NPI:1184948911
Name:GLEASON, MEGAN M (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRAP FALLS RD STE 404
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7622
Mailing Address - Country:US
Mailing Address - Phone:203-734-7900
Mailing Address - Fax:203-513-3269
Practice Address - Street 1:2 TRAP FALLS RD STE 404
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7622
Practice Address - Country:US
Practice Address - Phone:203-734-7900
Practice Address - Fax:203-513-3269
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT55574207XX0005X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program