Healthcare Provider Details

I. General information

NPI: 1255854931
Provider Name (Legal Business Name): MEGHANN L MARVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 09/20/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 202E
BURLINGTON MA
01803-5141
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8082
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-7000
  • Fax: 781-744-5351
Mailing address:
  • Phone: 860-679-4477
  • Fax: 860-679-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN285396
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number010200
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number010200
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: