Healthcare Provider Details

I. General information

NPI: 1245541093
Provider Name (Legal Business Name): ROBERT MICHAEL MEADOWS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 SHIPYARD BLVD
WILMINGTON NC
28403-6161
US

IV. Provider business mailing address

1615 CAROLINA BEACH AVE N APT E14
CAROLINA BEACH NC
28428-7005
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-0075
  • Fax:
Mailing address:
  • Phone: 910-818-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: