Provider Demographics
NPI:1326481391
Name:KISTLER, MEGAN RAE (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAE
Last Name:KISTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:RAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1811 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE A106
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1111
Mailing Address - Country:US
Mailing Address - Phone:215-836-1700
Mailing Address - Fax:215-836-2705
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:SUITE A106
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-836-1700
Practice Address - Fax:215-836-2705
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD457127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program