Provider Demographics
NPI:1265587158
Name:SASS, MEGHAN BANIK (MD)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:BANIK
Last Name:SASS
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 1:159 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2422
Mailing Address - Country:US
Mailing Address - Phone:508-226-0213
Mailing Address - Fax:
Practice Address - Street 1:159 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2422
Practice Address - Country:US
Practice Address - Phone:508-226-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238428207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME8507626OtherCIGNA
MA110087016AMedicaid
MA9521590OtherAETNA
MAAA189835OtherHPHC
MAAA189835OtherHPHC