1790253193 NPI number — MISS MEGHAN KATHERINE CAWLEY PA-C

Table of content: MISS MEGHAN KATHERINE CAWLEY PA-C (NPI 1790253193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790253193 NPI number — MISS MEGHAN KATHERINE CAWLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAWLEY
Provider First Name:
MEGHAN
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790253193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 PARKVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18444-8634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-351-1936
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 N WASHINGTON AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-5522
Provider Business Practice Location Address Fax Number:
570-207-7240
Provider Enumeration Date:
11/05/2018

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:  MA060322 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1982791117 . This is a "DERMATOLOGY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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