Provider Demographics
NPI:1245413293
Name:DOUGAN, MEGAN J (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:J
Last Name:DOUGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:J
Other - Last Name:KIMMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:240 W 11TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1702
Mailing Address - Country:US
Mailing Address - Phone:814-452-2218
Mailing Address - Fax:814-455-2925
Practice Address - Street 1:240 W 11TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1702
Practice Address - Country:US
Practice Address - Phone:814-452-2218
Practice Address - Fax:814-455-2925
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053290363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA053290OtherLICENSE
PA11910FTGMedicare PIN