Healthcare Provider Details

I. General information

NPI: 1710972229
Provider Name (Legal Business Name): TONYA P MEADE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 SHERMAN DR
PRINCETON IN
47670
US

IV. Provider business mailing address

2022 SHERMAN DR
PRINCETON IN
47670
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-1071
  • Fax: 812-385-8793
Mailing address:
  • Phone: 812-385-1071
  • Fax: 812-385-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002400A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02002400A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: