Healthcare Provider Details

I. General information

NPI: 1003273087
Provider Name (Legal Business Name): MEGAN ANN ALLISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CANDLEWOOD CT
LYNCHBURG VA
24502-2654
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 434-363-4190
  • Fax: 434-363-4191
Mailing address:
  • Phone: 920-663-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: