MEDICARE: DR. CONOR PAUL MEEHAN MB, BCH, BAO, MRCPI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	P65223	NY

General Provider Information

NPI Number	:	1215192950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONOR PAUL MEEHAN MB, BCH, BAO, MRCPI

Provider Business Mailing Address
First Line	:	10945 LE CONTE AVE, PETER V UEBERROTH BUILDING
Second Line	:	STE 3371
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7206
Country	:	US
Telephone Number	:	917-318-3407
Fax Number	:

Provider Business Practice Location Address
First Line	:	10945 LE CONTE AVE, PETER V UEBERROTH BUILDING
Second Line	:	STE 3371
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7206
Country	:	US
Telephone Number	:	917-318-3407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	05/25/2010

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