Provider Demographics
NPI:1518514892
Name:FERNANDEZ, MEAGAN ALEXANDRA-WARD (PA-C)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ALEXANDRA-WARD
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:ALEXANDRA-WARD
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2700 QUARRY LAKE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3746
Mailing Address - Country:US
Mailing Address - Phone:410-377-8900
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3746
Practice Address - Country:US
Practice Address - Phone:410-377-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant