Healthcare Provider Details

I. General information

NPI: 1043520828
Provider Name (Legal Business Name): MEGAN MICHELLE WHITEHOUSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 HARRISON AVE STE. 303
CINCINNATI OH
45247-7961
US

IV. Provider business mailing address

5300 FAR HILLS AVE
DAYTON OH
45429-2381
US

V. Phone/Fax

Practice location:
  • Phone: 513-541-5051
  • Fax: 513-541-4035
Mailing address:
  • Phone: 937-312-3820
  • Fax: 937-433-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50-003182
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: