Healthcare Provider Details

I. General information

NPI: 1932553120
Provider Name (Legal Business Name): MEREDITH ADAORA OKWESILI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610
US

IV. Provider business mailing address

401 HADDON AVE SUITE 352
CAMDEN NJ
08103-1505
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-2473
  • Fax: 508-334-2780
Mailing address:
  • Phone: 617-259-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR9829
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: