Provider Demographics
NPI:1992750533
Name:MEHAN, NANCY (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MEHAN
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:PO BOX 75567
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5567
Mailing Address - Country:US
Mailing Address - Phone:888-898-3294
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-3111
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICMD12097207P00000X
VA0101243860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007058742OtherMEDICARE
RI939025129OtherRI MEDICARE GROUP NUMBER
VA1992750533Medicaid
RI1992750533OtherNPI
RI7058742Medicaid
VA1992750533Medicaid