Healthcare Provider Details

I. General information

NPI: 1750805461
Provider Name (Legal Business Name): MEGAN JO FERRITTO MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN JO SPEZIALE MPAS, PA-C

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 HEALTH PARK DR STE 150
GARNER NC
27529-7051
US

IV. Provider business mailing address

1306 CONCOURSE DR STE 201
LINTHICUM HEIGHTS MD
21090-1033
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-3487
  • Fax: 919-772-3446
Mailing address:
  • Phone: 813-882-9986
  • Fax: 813-341-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-07439
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07439
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: