Provider Demographics
NPI:1407191950
Name:CRAWFORD, MEGAN COLLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:COLLEEN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-3229
Mailing Address - Country:US
Mailing Address - Phone:570-239-6509
Mailing Address - Fax:570-759-1642
Practice Address - Street 1:301 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3603
Practice Address - Country:US
Practice Address - Phone:570-759-0351
Practice Address - Fax:570-759-1642
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055908363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical