Provider Demographics
NPI:1700550688
Name:MATHEWS, MEGAN ELISE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12754 GLADYS RETREAT CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3350
Mailing Address - Country:US
Mailing Address - Phone:215-715-9384
Mailing Address - Fax:
Practice Address - Street 1:6700 LAUREL BOWIE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1707
Practice Address - Country:US
Practice Address - Phone:301-809-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDV-08588208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery