Provider Demographics
NPI:1053594309
Name:CONNOLLY, MEGHAN (MS EI)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MS EI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4881
Mailing Address - Country:US
Mailing Address - Phone:508-747-2012
Mailing Address - Fax:508-747-4898
Practice Address - Street 1:64 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4881
Practice Address - Country:US
Practice Address - Phone:508-747-2012
Practice Address - Fax:508-747-4898
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist