Healthcare Provider Details

I. General information

NPI: 1548796295
Provider Name (Legal Business Name): MERIDYTH BUSCHARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7703 FLOYD CURL DR # MC7977
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-4000
  • Fax: 210-358-0647
Mailing address:
  • Phone: 210-358-4000
  • Fax: 210-358-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8010
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS8010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: