Provider Demographics
NPI:1750687661
Name:LESSARD, MEGAN E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:LESSARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:603-319-6223
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:42 NASHUA ROAD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-413-6800
Practice Address - Fax:603-413-6803
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICPA00657363A00000X, 363AM0700X
WI2719-23363AM0700X
NH1804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750687661Medicaid
MN1750687661Medicaid
WI1750687661Medicaid