MEDICARE: MEGAN NOEL BLACKBURN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1699	WV
2	363A00000X	Physician Assistant	50.006761RX	OH
3	363AM0700X	Medical Physician Assistant	PENDING	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1699	OTHER	WV	LICENSE

General Provider Information

NPI Number	:	1023432093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN NOEL BLACKBURN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 WASHINGTON BLVD STE G
Second Line	:	PHYSICIANS CARE EXPRESS - BELPRE
City	:	BELPRE
State	:	OH
Zip	:	45714-4005
Country	:	US
Telephone Number	:	740-423-3240
Fax Number	:	740-401-0440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/19/2026

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