Healthcare Provider Details

I. General information

NPI: 1932132305
Provider Name (Legal Business Name): MEAGAN LYN WEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FREDERICK RD
THURMONT MD
21788-1809
US

IV. Provider business mailing address

1410 NEW RD
ORRTANNA PA
17353-9238
US

V. Phone/Fax

Practice location:
  • Phone: 301-979-9636
  • Fax: 717-338-9070
Mailing address:
  • Phone: 717-677-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055432
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002762
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: