1104519685 NPI number — MEGAN ELIZABETH MCCARTNEY

Table of content: MEGAN ELIZABETH MCCARTNEY (NPI 1104519685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104519685 NPI number — MEGAN ELIZABETH MCCARTNEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTNEY
Provider First Name:
MEGAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENNISON
Provider Other First Name:
MEGAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104519685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5982 RHODES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240-8100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-673-1347
Provider Business Mailing Address Fax Number:
330-678-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 TUSCARAWAS ST W STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44702-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-438-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2023

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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