Healthcare Provider Details

I. General information

NPI: 1417148636
Provider Name (Legal Business Name): MEAGHAN L CONNORS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY STE 4190
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

1330 LINCOLN AVE STE 303
SAN RAFAEL CA
94901-2143
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4635
  • Fax: 510-204-3060
Mailing address:
  • Phone: 510-809-0160
  • Fax: 415-454-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC56008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: