Healthcare Provider Details

I. General information

NPI: 1760412894
Provider Name (Legal Business Name): BRIAN CHARLES MEADERS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130
US

IV. Provider business mailing address

150 S. HUNTINGTON AVENUE
BOSTON MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-0540
  • Fax:
Mailing address:
  • Phone: 857-364-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.A10057
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.A10057
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: