Provider Demographics
NPI:1932132305
Name:WEAVER, MEAGAN LYN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:LYN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NEW RD
Mailing Address - Street 2:
Mailing Address - City:ORRTANNA
Mailing Address - State:PA
Mailing Address - Zip Code:17353-9238
Mailing Address - Country:US
Mailing Address - Phone:717-677-6971
Mailing Address - Fax:
Practice Address - Street 1:1311 BIGLERVILLE RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8019
Practice Address - Country:US
Practice Address - Phone:717-334-8165
Practice Address - Fax:717-338-9070
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002762363A00000X
PAMA055432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD173MR908Medicare PIN