Healthcare Provider Details

I. General information

NPI: 1538493028
Provider Name (Legal Business Name): MEGAN ELYSSE WEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ELYSSE PETERS PA-C

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 NORWIN AVE
NORTH HUNTINGDON PA
15642-2718
US

IV. Provider business mailing address

520 JEFFERSON AVE SUITE 400
JEANNETTE PA
15644-2538
US

V. Phone/Fax

Practice location:
  • Phone: 855-765-7277
  • Fax: 724-863-0046
Mailing address:
  • Phone: 724-527-8060
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054161
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: