Healthcare Provider Details

I. General information

NPI: 1205160801
Provider Name (Legal Business Name): MEREDITH RAPPAPORT PA-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH RAPPAPORT LCSW

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 FORTUNES RIDGE DR STE P
DURHAM NC
27713-6102
US

IV. Provider business mailing address

PO BOX 114
KINGFIELD ME
04947-0114
US

V. Phone/Fax

Practice location:
  • Phone: 919-319-7202
  • Fax: 919-391-7203
Mailing address:
  • Phone: 865-297-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW5010
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12177
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-12177
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5287
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: