Healthcare Provider Details

I. General information

NPI: 1235758079
Provider Name (Legal Business Name): MEGAN ILENE CROTTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2020
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12623 ECKEL JUNCTION RD STE 2600
PERRYSBURG OH
43551-1304
US

IV. Provider business mailing address

12623 ECKEL JUNCTION RD
PERRYSBURG OH
43551-1304
US

V. Phone/Fax

Practice location:
  • Phone: 567-368-1490
  • Fax: 567-368-1478
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.017997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: