Healthcare Provider Details

I. General information

NPI: 1689583205
Provider Name (Legal Business Name): MEGAN ELIZABETH CONKLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 THOMAS JOHNSON DR STE 101
FREDERICK MD
21702-4427
US

IV. Provider business mailing address

87 THOMAS JOHNSON DR STE 101
FREDERICK MD
21702-4427
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-0606
  • Fax:
Mailing address:
  • Phone: 301-694-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010733
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: