Provider Demographics
NPI:1841850039
Name:HART, MEGAN LOUISE (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LOUISE
Last Name:HART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:844-883-6065
Practice Address - Street 1:435 MERCHANT WALK SQ STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-6516
Practice Address - Country:US
Practice Address - Phone:434-654-1800
Practice Address - Fax:844-883-6065
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2555363A00000X, 363AM0700X, 363AS0400X
VA0110007199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical