=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902290810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN OLSEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2015
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88TH MEDICAL GROUP 4881 SUGAR MAPLE DRIVE
-----------------------------------------------------
City | WPAFB
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-257-1942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88TH MEDICAL GROUP 4881 SUGAR MAPLE DRIVE
-----------------------------------------------------
City | WPAFB
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-257-1942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0203X
-----------------------------------------------------
Taxonomy Name | Therapeutic Radiology Physician
-----------------------------------------------------
License Number | 35.137602
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 21617
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------