MEDICARE: MEGHAN MCCULLOUGH 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
1	208600000X	Surgery Physician	A133461	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207XS0106X	Orthopaedic Hand Surgery Physician	A133461	CA

General Provider Information

NPI Number	:	1265835383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN MCCULLOUGH MD

Provider Business Mailing Address
First Line	:	1510 SAN PABLO ST
Second Line	:	SUITE 514
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5320
Country	:	US
Telephone Number	:	703-371-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 W 3RD ST STE 990W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6116
Country	:	US
Telephone Number	:	310-423-5900
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	12/15/2022

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