Provider Demographics
NPI:1003128547
Name:GREENWADE, MAEGAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:E
Last Name:GREENWADE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAEGAN
Other - Middle Name:E
Other - Last Name:RISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2412 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9289
Mailing Address - Country:US
Mailing Address - Phone:570-295-0944
Mailing Address - Fax:
Practice Address - Street 1:4200 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2801
Practice Address - Country:US
Practice Address - Phone:717-558-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054400363AM0700X
PAOA003405363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical