Provider Demographics
NPI:1114424629
Name:ROSBOROUGH, MEGHAN (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:ROSBOROUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PSC 477 BOX 485
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96306-0005
Mailing Address - Country:US
Mailing Address - Phone:904-536-9822
Mailing Address - Fax:
Practice Address - Street 1:UNIT 45011 BOX BG
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:315-262-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116031535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics