Healthcare Provider Details

I. General information

NPI: 1508265828
Provider Name (Legal Business Name): PATRICIA MEEHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7483
  • Fax: 410-706-0406
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11629
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: