Provider Demographics
NPI:1467918367
Name:GRAMM, MEGAN RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAY
Last Name:GRAMM
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 1:1907 LEBANON CHURCH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2452
Mailing Address - Country:US
Mailing Address - Phone:412-650-9700
Mailing Address - Fax:
Practice Address - Street 1:1907 LEBANON CHURCH RD STE 101
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2452
Practice Address - Country:US
Practice Address - Phone:412-650-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant