Provider Demographics
NPI:1013095892
Name:MCGAVERN, MEGAN BROOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BROOKE
Last Name:MCGAVERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12652 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4392
Practice Address - Country:US
Practice Address - Phone:757-234-4285
Practice Address - Fax:757-234-4260
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013095892Medicaid
VAVV5808AMedicare PIN
VAP01090280Medicare PIN