Healthcare Provider Details

I. General information

NPI: 1780371385
Provider Name (Legal Business Name): MEGAN EUBANK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE # LG065
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4988
  • Fax:
Mailing address:
  • Phone: 860-679-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14278316-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: