Provider Demographics
NPI:1871258756
Name:MORAVA, MEGAN ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALEXANDRA
Last Name:MORAVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 QUEENS RD STE 600
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3580
Practice Address - Country:US
Practice Address - Phone:980-302-6600
Practice Address - Fax:980-302-6605
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4171363A00000X
NC0010-10471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant