Basic Information
| Provider Information | |||||||||
| NPI: | 1417390873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMISON | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | O'BRIEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | O'BRIEN | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 40 DUKE MEDICINE CIR # 3K | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277101033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843432 | ||||||||
| FaxNumber: | 9196846505 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 CROOKED CREEK PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277138507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193857546 | ||||||||
| FaxNumber: | 9193857566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | D83733 | MD | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MTL001732 | DC | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 2020-0186 | NC | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.