Healthcare Provider Details

I. General information

NPI: 1831728278
Provider Name (Legal Business Name): MEGAN THAYAMMAL CROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HANOVER ST
WILKES BARRE PA
18702-3540
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-8780
  • Fax: 570-825-8785
Mailing address:
  • Phone: 570-808-8780
  • Fax: 570-825-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME161072
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD495228
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: