Provider Demographics
NPI:1265907521
Name:ELLDEN, MEGHAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARIE
Last Name:ELLDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MARIE
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7942
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-7942
Mailing Address - Country:US
Mailing Address - Phone:540-207-7742
Mailing Address - Fax:
Practice Address - Street 1:125 OLDE GREENWICH DR STE 220
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4010
Practice Address - Country:US
Practice Address - Phone:540-898-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant