Healthcare Provider Details

I. General information

NPI: 1295705911
Provider Name (Legal Business Name): RAFFI G MEGERIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SHANNONDELL DR.
AUDUBON PA
19403-5615
US

IV. Provider business mailing address

10000 SHANNONDELL DR.
AUDUBON PA
19403-5615
US

V. Phone/Fax

Practice location:
  • Phone: 610-728-5241
  • Fax: 610-728-5322
Mailing address:
  • Phone: 610-728-5241
  • Fax: 610-728-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD421091
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD421091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: