Healthcare Provider Details

I. General information

NPI: 1497133409
Provider Name (Legal Business Name): MEGAN INDIGO EARLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

IV. Provider business mailing address

813 CLOVERCREST DR
ALEXANDRIA VA
22314-4815
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-7878
  • Fax:
Mailing address:
  • Phone: 310-633-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101266457
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: