1750805461 NPI number — MEGAN JO FERRITTO MPAS, PA-C

Table of content: MEGAN JO FERRITTO MPAS, PA-C (NPI 1750805461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750805461 NPI number — MEGAN JO FERRITTO MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRITTO
Provider First Name:
MEGAN
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPEZIALE
Provider Other First Name:
MEGAN
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPAS, PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750805461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1306 CONCOURSE DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTHICUM HEIGHTS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21090-1033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-882-9986
Provider Business Mailing Address Fax Number:
813-341-3259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HEALTH PARK DR STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-772-3487
Provider Business Practice Location Address Fax Number:
919-772-3446
Provider Enumeration Date:
08/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  0010-07439 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-07439 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 561744813 . This is a "PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0291F . This is a "BLUE CROSS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561744813 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561744813 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561744813 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890291F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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