Healthcare Provider Details

I. General information

NPI: 1275413460
Provider Name (Legal Business Name): MR. ANTONIO MEEHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-1400
  • Fax:
Mailing address:
  • Phone: 740-374-1796
  • Fax: 740-374-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0041334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: