Provider Demographics
NPI:1518943992
Name:PICCINI, MEGAN CORNWALL (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CORNWALL
Last Name:PICCINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 COMPUTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6506
Mailing Address - Country:US
Mailing Address - Phone:919-782-5273
Mailing Address - Fax:919-781-8853
Practice Address - Street 1:3801 COMPUTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6506
Practice Address - Country:US
Practice Address - Phone:919-782-5273
Practice Address - Fax:919-781-8853
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902250Medicaid