Provider Demographics
NPI:1366734451
Name:KOSTYAK, MEGAN MAY (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MAY
Last Name:KOSTYAK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-7237
Mailing Address - Fax:215-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:INTERVENTIONAL RADIOLOGY, SUITE A PARK PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2018-09-20
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Provider Licenses
StateLicense IDTaxonomies
PAMA052171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant