Healthcare Provider Details

I. General information

NPI: 1053724278
Provider Name (Legal Business Name): MEREDITH ANGEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-9662
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-9662
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-2471
  • Fax: 270-465-4669
Mailing address:
  • Phone: 270-789-2471
  • Fax: 270-465-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT206736
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberTP650
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: