Provider Demographics
NPI:1700112497
Name:WATERS, MEGAN SUZANNE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:SUZANNE
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUZANNE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7794 FIVE MILE ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230
Mailing Address - Country:US
Mailing Address - Phone:513-231-1575
Mailing Address - Fax:855-818-3918
Practice Address - Street 1:7794 5 MILE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2368
Practice Address - Country:US
Practice Address - Phone:513-231-1575
Practice Address - Fax:855-818-3918
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA34451Medicare UPIN