Healthcare Provider Details

I. General information

NPI: 1437100534
Provider Name (Legal Business Name): MEGAN O BRIDGEO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN O'DONNELL P.A.

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

PO BOX 626 ONE MEDICAL CENTER DRIVE
BIDDEFORD ME
04005
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax:
Mailing address:
  • Phone: 207-467-8988
  • Fax: 207-267-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1197
License Number StateME

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: