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General NPI Number Information
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NPI Number | 1467029454
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Entity Type | Individual
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Provider Name | MEGHAN MARIE BALLOU PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 3045 SOUTHWESTERN BLVD STE 104
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1209
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Country | US
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Telephone | 716-675-7000
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Fax | 716-674-4659
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Provider Business Mailing Address
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Address Line | 2760 KULP RD
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City | EDEN
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State | NY
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Zip | 14057-9410
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Country | US
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Telephone | 716-799-7686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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