Healthcare Provider Details

I. General information

NPI: 1437316692
Provider Name (Legal Business Name): MARISA LYN MEYER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA LYN FRESCHI DO

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND ROAD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

P.O. BOX 191
ROCKLAND DE
19723-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4200
  • Fax: 302-651-6410
Mailing address:
  • Phone: 302-651-4000
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD0000
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2008-01138
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: