Healthcare Provider Details

I. General information

NPI: 1225011000
Provider Name (Legal Business Name): KENNETH W MEADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER DEPT OB/GYN, CMR 402
APO AE
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUR-DCCS (CREDENTIALS), CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 011496371868124
  • Fax:
Mailing address:
  • Phone: 011496371868839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00018450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: