Provider Demographics
NPI:1437452414
Name:MCCROSSIN, MEGAN A (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:MCCROSSIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4618
Practice Address - Fax:207-662-6254
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA001248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001983601Medicare PIN
MEP01054356Medicare PIN