Provider Demographics
NPI:1326336603
Name:CLARK, MEGAN (PA)
Entity Type:Individual
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First Name:MEGAN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 411
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-3113
Mailing Address - Fax:856-968-8388
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-3113
Practice Address - Fax:856-968-8388
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2015-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMP00256500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMP00256500OtherSTATE LICENSE