MEDICARE: MEGON S DOLPH

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	163W00000X	Registered Nurse	RN5122061	PA

General Provider Information

NPI Number	:	1427337971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGON S DOLPH

Provider Business Mailing Address
First Line	:	515 STATE ROUTE 590
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-7731
Country	:	US
Telephone Number	:	570-558-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 STATE ROUTE 590
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-7731
Country	:	US
Telephone Number	:	570-558-5581
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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