MEDICARE: MEGAN S STOCK P.A.

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	363AM0700X	Medical Physician Assistant	002926	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002926	OTHER	CT	STATE LICENSE

General Provider Information

NPI Number	:	1972944957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN S STOCK P.A.

Provider Business Mailing Address
First Line	:	406 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1964
Country	:	US
Telephone Number	:	860-677-3950
Fax Number	:	860-724-4397

Provider Business Practice Location Address
First Line	:	406 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1964
Country	:	US
Telephone Number	:	860-677-3950
Fax Number	:	860-724-4397

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/14/2016

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Directions to “ MEGAN S STOCK P.A.” Practice Location

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