Healthcare Provider Details

I. General information

NPI: 1417660408
Provider Name (Legal Business Name): MEGAN VIOLETTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL
LINCOLN RI
02865-1179
US

IV. Provider business mailing address

335 RIGHTERS FERRY RD APT 502
BALA CYNWYD PA
19004-1749
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-6100
  • Fax:
Mailing address:
  • Phone: 856-745-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01633
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: