MEDICARE: MEGAN R JOINT DO

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	207N00000X	Dermatology Physician	OS018067	PA
2	207N00000X	Dermatology Physician	83734	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538429055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN R JOINT DO

Provider Business Mailing Address
First Line	:	485 TOM HALL ST STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2353
Country	:	US
Telephone Number	:	740-566-4621
Fax Number	:	740-331-7676

Provider Business Practice Location Address
First Line	:	485 TOM HALL ST STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2353
Country	:	US
Telephone Number	:	803-228-7972
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	12/06/2022

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Directions to “ MEGAN R JOINT DO” Practice Location

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