Provider Demographics
NPI:1750805461
Name:FERRITTO, MEGAN JO (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JO
Last Name:FERRITTO
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JO
Other - Last Name:SPEZIALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:501 HEALTH PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7051
Practice Address - Country:US
Practice Address - Phone:919-772-3487
Practice Address - Fax:919-772-3446
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07439363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561744813OtherPPO
NC0291FOtherBLUE CROSS OF NC
NC561744813OtherCIGNA
NC561744813OtherAETNA
NC561744813OtherUNITED HEALTHCARE
NC890291FMedicaid