Healthcare Provider Details

I. General information

NPI: 1609366178
Provider Name (Legal Business Name): MEREDITH PAIGE WHITTAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 EMPIRE CT
FREDERICKSBURG VA
22408-1939
US

IV. Provider business mailing address

1501 N CAMPBELL AVE RM 4334D
TUCSON AZ
85724-5058
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-2244
  • Fax:
Mailing address:
  • Phone: 520-626-7747
  • Fax: 520-626-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR76726
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: