Healthcare Provider Details

I. General information

NPI: 1558687962
Provider Name (Legal Business Name): MEREDITH GILLIS DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7555
  • Fax:
Mailing address:
  • Phone: 215-590-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70089
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD493172
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: