Healthcare Provider Details

I. General information

NPI: 1790253193
Provider Name (Legal Business Name): MEGHAN KATHERINE CAWLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N WASHINGTON AVE STE 200
SCRANTON PA
18503-1535
US

IV. Provider business mailing address

916 PARKVIEW RD
MOSCOW PA
18444-8634
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-5522
  • Fax: 570-207-7240
Mailing address:
  • Phone: 570-351-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA060322
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1982791117
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerDERMATOLOGY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: