Provider Demographics
NPI:1154171635
Name:BERRY, MEGAN LEE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:MCEACHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 WEWATTA ST UNIT 430
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6653
Mailing Address - Country:US
Mailing Address - Phone:248-880-9871
Mailing Address - Fax:
Practice Address - Street 1:750 W HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2165
Practice Address - Country:US
Practice Address - Phone:303-578-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program