Individual
MEGAN KELLEY MATHIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8105 RITCHIE HWY, PASADENA, MD 21122-3905
(443) 573-0564
(443) 573-0565
Mailing address
PO BOX 759047, BALTIMORE, MD 21275-9047
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0003894
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149619
MEDICARE GROUP PTAN
MD
01
—
945L
MEDICARE GROUP PTAN
MD
Enumeration date
10/10/2008
Last updated
02/29/2024
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