Provider Demographics
NPI:1447249347
Name:COLEMAN, MEGHAN O (CRNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:O
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1702
Mailing Address - Country:US
Mailing Address - Phone:610-617-2400
Mailing Address - Fax:
Practice Address - Street 1:3941 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1104
Practice Address - Country:US
Practice Address - Phone:215-481-4000
Practice Address - Fax:215-481-7438
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005935X363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0028185Medicaid
Q21301Medicare UPIN
NJ0028185Medicaid