Provider Demographics
NPI:1881458412
Name:RANSOME, MAEGAN PRYREN
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:PRYREN
Last Name:RANSOME
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 1:9308 OPERATOR CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4008
Mailing Address - Country:US
Mailing Address - Phone:540-816-7010
Mailing Address - Fax:
Practice Address - Street 1:612 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5120
Practice Address - Country:US
Practice Address - Phone:803-386-8684
Practice Address - Fax:844-364-9446
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29039207Q00000X
VA0001265326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily