Provider Demographics
NPI:1265732093
Name:FLUHARTY, MEGAN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:FLUHARTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:MATHIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-865-0556
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:STE 3
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-865-0555
Practice Address - Fax:304-865-0556
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA37011Medicare PIN