Provider Demographics
NPI:1144401571
Name:CANTON FEDER, MEAGHAN MARY (NP)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:MARY
Last Name:CANTON FEDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:MARY
Other - Last Name:CANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3613 S ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2245
Mailing Address - Country:US
Mailing Address - Phone:202-422-5903
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 730
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4447
Practice Address - Country:US
Practice Address - Phone:301-951-2400
Practice Address - Fax:877-285-1490
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1003040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00894790OtherRAILROAD MEDICARE
DC131662YT2Medicare PIN