Provider Demographics
NPI:1205151768
Name:PAULUS, MEGAN CARROLL (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CARROLL
Last Name:PAULUS
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 1:14 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3472
Mailing Address - Country:US
Mailing Address - Phone:631-444-4233
Mailing Address - Fax:631-444-4217
Practice Address - Street 1:14 TECHNOLOGY DR
Practice Address - Street 2:SUITE 11
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3472
Practice Address - Country:US
Practice Address - Phone:631-444-4233
Practice Address - Fax:631-444-4217
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282261207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery