Healthcare Provider Details

I. General information

NPI: 1952370751
Provider Name (Legal Business Name): CHRISTIAN JAMES MEKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 MOUNT BELVEDERE BLVD FORT DRUM MEDDAC
FORT DRUM NY
13602-5438
US

IV. Provider business mailing address

11050 MT BELVEDERE BLVD FORT DRUM MEDDAC
FORT DRUM NY
13602
US

V. Phone/Fax

Practice location:
  • Phone: 315-774-2643
  • Fax: 315-774-2639
Mailing address:
  • Phone: 315-774-2643
  • Fax: 315-774-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236199
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: