Provider Demographics
NPI:1851794747
Name:TUMULTY, MEGAN (NP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TUMULTY
Suffix:
Gender:F
Credentials:NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 WIDOWS MITE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2144
Mailing Address - Country:US
Mailing Address - Phone:208-724-3403
Mailing Address - Fax:
Practice Address - Street 1:2620 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7305
Practice Address - Country:US
Practice Address - Phone:208-724-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner