Provider Demographics
NPI:1043520828
Name:WHITEHOUSE, MEGAN MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELLE
Last Name:WHITEHOUSE
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 1:5300 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2381
Mailing Address - Country:US
Mailing Address - Phone:937-312-3820
Mailing Address - Fax:937-433-9612
Practice Address - Street 1:6480 HARRISON AVE
Practice Address - Street 2:STE. 303
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7961
Practice Address - Country:US
Practice Address - Phone:513-541-5051
Practice Address - Fax:513-541-4035
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-003182363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH570303OtherWELLCARE
OH9963606OtherAETNA
OH000000684745OtherANTHEM
OH9963606OtherAETNA
OH570303OtherWELLCARE