Provider Demographics
NPI:1548201973
Name:BAZIL, MEGAN K (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:BAZIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2117 MCCOMAS WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3908
Mailing Address - Country:US
Mailing Address - Phone:757-668-6715
Mailing Address - Fax:757-668-6690
Practice Address - Street 1:2117 MCCOMAS WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-668-6715
Practice Address - Fax:757-668-6690
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101239700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010396271Medicaid