Provider Demographics
NPI:1396326500
Name:LACKEY, MEYGAN J (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MEYGAN
Middle Name:J
Last Name:LACKEY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MEYGAN
Other - Middle Name:JAMES
Other - Last Name:ELWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:DOWLING 5TH FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-4465
Practice Address - Fax:617-414-3345
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine