Healthcare Provider Details

I. General information

NPI: 1295437291
Provider Name (Legal Business Name): MEGAN ELIZABETH PUDLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 CHAMBERS RD
HORSEHEADS NY
14845-1403
US

IV. Provider business mailing address

3344 CHAMBERS RD
HORSEHEADS NY
14845-1403
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-2264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number345592
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD496831
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: