Healthcare Provider Details

I. General information

NPI: 1508194143
Provider Name (Legal Business Name): MEGHAN DOLAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NORTHWESTERN DR STE 305
BLOOMFIELD CT
06002-3428
US

IV. Provider business mailing address

6 NORTHWESTERN DR STE 305
BLOOMFIELD CT
06002-3428
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-8591
  • Fax: 860-242-2511
Mailing address:
  • Phone: 860-242-8591
  • Fax: 860-242-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA054142
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2861
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: