MEDICARE: MEGAN ELIZABETH AHMED 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	6715	AZ

General Provider Information

NPI Number	:	1962802736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELIZABETH AHMED PA-C

Provider Business Mailing Address
First Line	:	7463 W LONE CACTUS DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 NORTERRA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8204
Country	:	US
Telephone Number	:	623-715-7055
Fax Number	:

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

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	10/19/2017

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