MEDICARE: MEGHAN ROSE RONAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1942088042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN ROSE RONAN

Provider Business Mailing Address
First Line	:	520 W FAYETTE ST STE 300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2613 EVERGREEN RD
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-2310
Country	:	US
Telephone Number	:	443-924-4765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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Directions to “ MEGHAN ROSE RONAN ” Practice Location

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