Healthcare Provider Details

I. General information

NPI: 1104036391
Provider Name (Legal Business Name): MERIDIAN PSYCHOTHERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax: 757-460-7744
Mailing address:
  • Phone: 757-460-4655
  • Fax: 757-460-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL E BOHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 757-460-4655