Provider Demographics
NPI:1225399447
Name:HAGE, MEGHAN RAE (RPA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:RAE
Last Name:HAGE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4698
Mailing Address - Country:US
Mailing Address - Phone:716-608-7040
Mailing Address - Fax:716-608-7065
Practice Address - Street 1:4893 TRANSIT ROAD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043
Practice Address - Country:US
Practice Address - Phone:716-608-7040
Practice Address - Fax:716-608-7065
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical