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NPI Code Detail

MEDICARE: MEGAN WYNNE MD

MEDICARE:   MEGAN  WYNNE  MD
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
12084P0800XPsychiatry PhysicianMD423544PA

General Provider Information

NPI Number : 1184650137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN WYNNE MD
Provider Business Mailing Address
First Line : PO BOX 1361
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19105-1361
Country : US
Telephone Number : 215-923-8947
Fax Number :
Provider Business Practice Location Address
First Line : 100 W LEHIGH AVE
Second Line : COHMHAR
City : PHILADELPHIA
State : PA
Zip : 19133-4039
Country : US
Telephone Number : 215-203-3000
Fax Number : 215-203-3078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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