Healthcare Provider Details

I. General information

NPI: 1356901565
Provider Name (Legal Business Name): MEGHAN ELIZABETH MCCABE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD STE 1
PHILADELPHIA PA
19141-3098
US

IV. Provider business mailing address

870 INDEPENDENCE CT
PHILADELPHIA PA
19147-4311
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7890
  • Fax:
Mailing address:
  • Phone: 215-262-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060594
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: