Provider Demographics
NPI:1124065891
Name:MEGERIAN, JONATHAN THOMAS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:MEGERIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:MEGERIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:6 NANCYS WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1439
Mailing Address - Country:US
Mailing Address - Phone:617-293-9370
Mailing Address - Fax:
Practice Address - Street 1:170 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2801
Practice Address - Country:US
Practice Address - Phone:714-288-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81401208000000X, 2084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140652Medicaid
MA3140652Medicaid