MEDICARE: MR. ROBERT JOSEPH MEACHAM LICENSED PSYCHOLOGIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS004070-L	PA

General Provider Information

NPI Number	:	1720237530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOSEPH MEACHAM LICENSED PSYCHOLOGIS

Provider Business Mailing Address
First Line	:	1965 LYCOMING CREEK ROAD SUITE 208
Second Line	:	THE CARL E. STOTZ BUILDING
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701
Country	:	US
Telephone Number	:	570-220-9228
Fax Number	:	570-326-7301

Provider Business Practice Location Address
First Line	:	1965 LYCOMING CREEK ROAD SUITE 208
Second Line	:	THE CARL E. STOTZ BUILDING
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701
Country	:	US
Telephone Number	:	570-220-9228
Fax Number	:	570-326-7301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/23/2008

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