Healthcare Provider Details

I. General information

NPI: 1750815650
Provider Name (Legal Business Name): DR. MEAGAN VAITSES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

IV. Provider business mailing address

6 STACEY LN
MADISON CT
06443-2464
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-6000
  • Fax:
Mailing address:
  • Phone: 203-676-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number77563
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number77563
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: