Provider Demographics
NPI:1700196086
Name:CODY, MEGAN P (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:P
Last Name:CODY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:PELNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 ATRIUM DR STE 100
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1441
Mailing Address - Country:US
Mailing Address - Phone:518-435-2740
Mailing Address - Fax:518-649-4025
Practice Address - Street 1:1444 WESTERN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3440
Practice Address - Country:US
Practice Address - Phone:518-452-0587
Practice Address - Fax:518-218-0152
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015317OtherLICENSRE
NY015317OtherLICENSRE