Healthcare Provider Details

I. General information

NPI: 1124756143
Provider Name (Legal Business Name): MEGHAN RENEE WILBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/29/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 NIAGARA ST BLDG 2
BUFFALO NY
14201-1108
US

IV. Provider business mailing address

564 NIAGARA ST BLDG 2
BUFFALO NY
14201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 855-442-8146
  • Fax:
Mailing address:
  • Phone: 716-882-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028605-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: