Healthcare Provider Details

I. General information

NPI: 1861681397
Provider Name (Legal Business Name): ANIL MEESALA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HORSEPOND RD
DOVER DE
19901-7232
US

IV. Provider business mailing address

285 CARDIFF WAY
BEAR DE
19701-8302
US

V. Phone/Fax

Practice location:
  • Phone: 302-747-1401
  • Fax:
Mailing address:
  • Phone: 267-253-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberC1-0010108
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: