Healthcare Provider Details

I. General information

NPI: 1306510474
Provider Name (Legal Business Name): MEGAN MATT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 S MAIN ST
CENTERVILLE OH
45458-3439
US

IV. Provider business mailing address

896 S MAIN ST
CENTERVILLE OH
45458-3439
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-6513
  • Fax:
Mailing address:
  • Phone: 937-433-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: