Provider Demographics
NPI:1700125580
Name:NORTHUP, MEGAN R (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:NORTHUP
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 1:2110 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5437
Mailing Address - Country:US
Mailing Address - Phone:913-205-8757
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2591
Practice Address - Country:US
Practice Address - Phone:620-343-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37199207V00000X
CAA180616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN