Provider Demographics
NPI:1538358379
Name:LINGENFELTER, MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:DEITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1279
Mailing Address - Country:US
Mailing Address - Phone:681-282-5591
Mailing Address - Fax:681-282-5591
Practice Address - Street 1:608 NEW HOPE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2273
Practice Address - Country:US
Practice Address - Phone:681-282-5591
Practice Address - Fax:681-282-5593
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMD1567140OtherDEA