Provider Demographics
NPI:1548635477
Name:BRODY, MEGAN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:BRODY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10000 LINCOLN DR E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3108
Mailing Address - Country:US
Mailing Address - Phone:856-630-2931
Mailing Address - Fax:703-521-5991
Practice Address - Street 1:10000 LINCOLN DR E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3108
Practice Address - Country:US
Practice Address - Phone:856-630-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005111363A00000X
NJ25MP00415400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant