Provider Demographics
NPI:1396149357
Name:MCCLEARY, MEGAN M (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:MORANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:480 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4780
Mailing Address - Country:US
Mailing Address - Phone:724-431-4190
Mailing Address - Fax:724-431-4192
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-431-4190
Practice Address - Fax:724-431-4192
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA057222OtherLICENSE