Healthcare Provider Details

I. General information

NPI: 1790970804
Provider Name (Legal Business Name): FREDERICK G. MEOLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FREDERICK G MEOLI D.O.

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 HARROWGATE DR
CHERRY HILL NJ
08003-1939
US

IV. Provider business mailing address

87 HARROWGATE DR
CHERRY HILL NJ
08003-1939
US

V. Phone/Fax

Practice location:
  • Phone: 856-489-1656
  • Fax: 856-424-2128
Mailing address:
  • Phone: 856-489-1656
  • Fax: 856-424-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB02322500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: