Healthcare Provider Details

I. General information

NPI: 1740292663
Provider Name (Legal Business Name): DAVID P. MEAGHER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S PLAZA
DAYTON OH
45404-1815
US

IV. Provider business mailing address

554 RIVERWOOD DR
BEAVERCREEK OH
45430-1642
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5020
  • Fax: 937-641-3107
Mailing address:
  • Phone: 937-885-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35.091348
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.091348
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC50457
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberC50457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: