Healthcare Provider Details

I. General information

NPI: 1881979870
Provider Name (Legal Business Name): TAMMI L MEADE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMI L PETERSON

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE BLDG N GROUND
WEST READING PA
19611-2143
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-0900
  • Fax: 484-628-0901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: