Healthcare Provider Details

I. General information

NPI: 1700405149
Provider Name (Legal Business Name): MEGAN ELIZABETH GOULD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEWIS AVE
MERIDEN CT
06451-2101
US

IV. Provider business mailing address

26 FARMINGTON MEADOW DR
FARMINGTON CT
06032-2041
US

V. Phone/Fax

Practice location:
  • Phone: 203-694-8200
  • Fax:
Mailing address:
  • Phone: 631-521-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004832
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: