Basic Information
| Provider Information | |||||||||
| NPI: | 1528318565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARON | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KENNEY | ||||||||
| OtherFirstName: | MEGHAN | ||||||||
| OtherMiddleName: | CHRISTINA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4 CRESCENT ST | ||||||||
| Address2: | |||||||||
| City: | PENACOOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033031412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037534302 | ||||||||
| FaxNumber: | 6037536213 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CRESCENT ST | ||||||||
| Address2: | |||||||||
| City: | PENACOOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033031412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037534302 | ||||||||
| FaxNumber: | 6037536213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA1453 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 0915 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA1453 | 01 | NV | PA-C LICENSURE | OTHER | 33300054 | 05 | NH | MEDICAID |