Provider Demographics
NPI:1770764029
Name:EAST, MEGHAN SUZANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:SUZANNE
Last Name:EAST
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 1:31413 WINTERPLACE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1877
Mailing Address - Country:US
Mailing Address - Phone:410-860-0100
Mailing Address - Fax:410-860-4894
Practice Address - Street 1:31413 WINTERPLACE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1877
Practice Address - Country:US
Practice Address - Phone:410-860-0100
Practice Address - Fax:410-860-4894
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003610363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0003610OtherMD BOARD OF PHYSICIANS