Healthcare Provider Details

I. General information

NPI: 1154453538
Provider Name (Legal Business Name): MERIDIAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

IV. Provider business mailing address

PO BOX 1088
SAINT ALBANS VT
05478-1088
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-5911
  • Fax:
Mailing address:
  • Phone: 802-527-1405
  • Fax: 802-933-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM A ROBERTS
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 802-524-5911