MEDICARE: MEGAN MALO PA

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	363AS0400X	Surgical Physician Assistant	PA8163	MA

General Provider Information

NPI Number	:	1720653405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MALO PA

Provider Business Mailing Address
First Line	:	200 MILL RD STE 180
Second Line	:
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5255
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 PRESIDENT AVE STE 110
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-5928
Country	:	US
Telephone Number	:	508-973-7690
Fax Number	:	508-973-1715

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	09/11/2024

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Directions to “ MEGAN MALO PA” Practice Location

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