Healthcare Provider Details

I. General information

NPI: 1902290810
Provider Name (Legal Business Name): MEGHAN OLSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAN MARIE PATZKE MD

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88TH MEDICAL GROUP 4881 SUGAR MAPLE DRIVE
WPAFB OH
45433
US

IV. Provider business mailing address

88TH MEDICAL GROUP 4881 SUGAR MAPLE DRIVE
WPAFB OH
45433
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-1942
  • Fax:
Mailing address:
  • Phone: 937-257-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number35.137602
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21617
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: