Provider Demographics
NPI:1780687723
Name:HARGRAVE, MEGAN EILEEN (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:EILEEN
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:EILEEN
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:220 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1137
Mailing Address - Country:US
Mailing Address - Phone:856-629-7436
Mailing Address - Fax:856-875-4742
Practice Address - Street 1:220 PINE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1137
Practice Address - Country:US
Practice Address - Phone:856-629-7436
Practice Address - Fax:856-875-4742
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB068236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33132Medicare UPIN
046428DGKMedicare ID - Type Unspecified