Provider Demographics
NPI:1699050500
Name:WILOCK, MEGHAN ELISE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELISE
Last Name:WILOCK
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43 OLD BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1857
Mailing Address - Country:US
Mailing Address - Phone:518-495-6072
Mailing Address - Fax:
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5088
Practice Address - Fax:518-262-5400
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015198363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical