Healthcare Provider Details

I. General information

NPI: 1376287029
Provider Name (Legal Business Name): MERIDIAN PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032-8774
US

IV. Provider business mailing address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032-8774
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-5351
  • Fax: 317-805-0380
Mailing address:
  • Phone: 317-844-5351
  • Fax: 317-805-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A BERGSTEIN
Title or Position: OWNER
Credential: MD
Phone: 317-844-5351