Healthcare Provider Details

I. General information

NPI: 1649569187
Provider Name (Legal Business Name): MEREDITH ANN LUCKENBAUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US

IV. Provider business mailing address

18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-8212
  • Fax: 302-645-5041
Mailing address:
  • Phone: 302-645-8212
  • Fax: 302-645-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0010951
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: