Provider Demographics
NPI:1467029454
Name:BALLOU, MEGHAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARIE
Last Name:BALLOU
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 1:2760 KULP RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9410
Mailing Address - Country:US
Mailing Address - Phone:716-799-7686
Mailing Address - Fax:
Practice Address - Street 1:3045 SOUTHWESTERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1209
Practice Address - Country:US
Practice Address - Phone:716-675-7000
Practice Address - Fax:716-674-4659
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant