Provider Demographics
NPI:1881029007
Name:GAVAN, MEAGHAN ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEAGHAN
Middle Name:ROSE
Last Name:GAVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEAGHAN
Other - Middle Name:ROSE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:234 INDUSTRIAL WAY W STE A103
Mailing Address - Street 2:SUITE A
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4257
Mailing Address - Country:US
Mailing Address - Phone:848-208-2055
Mailing Address - Fax:
Practice Address - Street 1:234 INDUSTRIAL WAY W STE A103
Practice Address - Street 2:SUITE A
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4257
Practice Address - Country:US
Practice Address - Phone:848-208-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00308500363A00000X
NY016624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant