Healthcare Provider Details

I. General information

NPI: 1508552803
Provider Name (Legal Business Name): MEGAN LUFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD # E-160
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

345 BLACKSTONE BLVD # E-160
PROVIDENCE RI
02906-4800
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6375
  • Fax:
Mailing address:
  • Phone: 401-455-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLP05977
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: