Provider Demographics
NPI:1922251412
Name:DONOVAN, MEGAN CHARLOTTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:CHARLOTTE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2012 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-569-9429
Mailing Address - Fax:410-569-9423
Practice Address - Street 1:2012 TOLLGATE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-569-9429
Practice Address - Fax:410-569-9423
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant