Provider Demographics
NPI:1689834079
Name:PUTMAN, MEGAN MARSHALL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARSHALL
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ANNE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:194 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:240-215-6310
Mailing Address - Fax:240-566-7751
Practice Address - Street 1:504 E. RIDGEVILLE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:MT. AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771
Practice Address - Country:US
Practice Address - Phone:240-215-6310
Practice Address - Fax:240-566-7751
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical