Provider Demographics
NPI:1972731396
Name:BARTRAM, MEGAN M (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:BARTRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:723 9TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2718
Practice Address - Country:US
Practice Address - Phone:304-529-0645
Practice Address - Fax:304-529-2048
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068583Medicaid
WV3810023563Medicaid
KY7100206650Medicaid
OH0068583Medicaid
KY7100206650Medicaid