Provider Demographics
NPI:1518387349
Name:EATON, MEGAN JANE (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:EATON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1434
Mailing Address - Country:US
Mailing Address - Phone:317-773-0760
Mailing Address - Fax:
Practice Address - Street 1:1160 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9601
Practice Address - Country:US
Practice Address - Phone:317-984-9311
Practice Address - Fax:317-984-7302
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004975A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300048088Medicaid