Healthcare Provider Details

I. General information

NPI: 1104517507
Provider Name (Legal Business Name): MERADITH PORTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERADITH DICKENSHEETS DO

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MEMORIAL DR
PINEHURST NC
28374-8710
US

IV. Provider business mailing address

1604 NC 5 HWY
ABERDEEN NC
28315-8661
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-1000
  • Fax:
Mailing address:
  • Phone: 910-692-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026-03899
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: