Provider Demographics
NPI:1568917409
Name:DAMAZO, MEGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DAMAZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:HEIRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3533
Mailing Address - Country:US
Mailing Address - Phone:412-373-1600
Mailing Address - Fax:412-373-4197
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3533
Practice Address - Country:US
Practice Address - Phone:412-373-1600
Practice Address - Fax:412-373-4197
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032357560001Medicaid
PA13947753OtherCAQH
PA13947753OtherCAQH