Healthcare Provider Details

I. General information

NPI: 1427637701
Provider Name (Legal Business Name): VENKATA MEKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 380A
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8650
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB12256100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: