Provider Demographics
NPI:1992175798
Name:HAAS, MEGAN (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 5650
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-294-3611
Mailing Address - Fax:937-294-9010
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 5650
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-294-3611
Practice Address - Fax:937-294-9010
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.004444363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH317051Medicare PIN
OHH317050Medicare PIN