Healthcare Provider Details

I. General information

NPI: 1932578143
Provider Name (Legal Business Name): MEGAN ELIZABETH PEIFFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

213 PERRY ST
FRANKLIN PA
16323-4419
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7890
  • Fax:
Mailing address:
  • Phone: 814-657-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057749
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: