Provider Demographics
NPI:1386082147
Name:FERDERBER, MEGAN L (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:FERDERBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:570-501-6368
Mailing Address - Fax:
Practice Address - Street 1:26 STATION CIR
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-9726
Practice Address - Country:US
Practice Address - Phone:570-861-8710
Practice Address - Fax:570-497-4046
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00865207Q00000X
PAMD458510207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386082147Medicaid
NC19QNWOtherBCBS
NCNCX278AOtherMEDICARE