Healthcare Provider Details

I. General information

NPI: 1720440498
Provider Name (Legal Business Name): MEGAN WURM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N FAIRFIELD RD. 110
BEAVERCREEK OH
45432-4543
US

IV. Provider business mailing address

1425 N FAIRFIELD RD STE 110
BEAVERCREEK OH
45432-2674
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-0106
  • Fax: 937-426-7153
Mailing address:
  • Phone: 937-426-0106
  • Fax: 379-426-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34013737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: