Healthcare Provider Details

I. General information

NPI: 1295799591
Provider Name (Legal Business Name): FELIX A MEZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E PARK AVE STE 112
STATE COLLEGE PA
16803-6706
US

IV. Provider business mailing address

PO BOX 854 MC A410
HERSHEY PA
17033-0854
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 717-531-5995
  • Fax: 717-531-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD422543
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD422543
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: