Provider Demographics
NPI:1730634288
Name:WALTERS, MEGAN ANN-GOLDBERG (PAC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN-GOLDBERG
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2087 ACORN BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7306
Mailing Address - Country:US
Mailing Address - Phone:317-735-8856
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTHFIELD DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4498
Practice Address - Country:US
Practice Address - Phone:317-738-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003943A363A00000X
CAPA54933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant