Individual
MS. MEGAN KATHLEEN MALONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
211 N EDDY ST., SOUTH BEND, IN 46617-3096
(574) 237-9294
(574) 237-9259
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10001709A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000900037
BCBS BMG TRAUMA
IN
Enumeration date
09/09/2014
Last updated
09/01/2016
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