{
"Npi": {
"NPI": "1215192950",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MEEHAN",
"FirstName": "CONOR",
"MiddleName": "PAUL",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MB, BCH, BAO, MRCPI",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10945 LE CONTE AVE, PETER V UEBERROTH BUILDING",
"SecondLineMailingAddress": "STE 3371",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90095-7206",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-318-3407",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10945 LE CONTE AVE, PETER V UEBERROTH BUILDING",
"SecondLinePracticeLocationAddress": "STE 3371",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90095-7206",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "917-318-3407",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/22/2008",
"LastUpdateDate": "05/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085B0100X",
"TaxonomyName": "Body Imaging Physician",
"LicenseNumber": "P65223",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}