Provider Demographics
NPI:1720414220
Name:PAVLOVIC, MEGAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:PAVLOVIC
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 1:1422 PARKVIEW CIR
Mailing Address - Street 2:APT# 301
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4316
Mailing Address - Country:US
Mailing Address - Phone:610-360-5686
Mailing Address - Fax:
Practice Address - Street 1:528 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1911
Practice Address - Country:US
Practice Address - Phone:610-900-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04501363A00000X
PAMA060892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant