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General NPI Number Information
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NPI Number | 1548854375
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Entity Type | Individual
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Provider Name | MEGAN GRADY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 2346 TRENTON RD STE C
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City | LEVITTOWN
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State | PA
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Zip | 19056-1445
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Country | US
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Telephone | 215-945-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 301 VILLAGE DR APT 351
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3082
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Country | US
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Telephone | 203-885-8637
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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 | OA005496
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License Number State | PA
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